3.4.Relationship between EMT markers and OS
Thirty-five (38%) cases with E-cadherin overexpression and 3 (42.9%) cases with E-cadherin downregulation died. There was no statistically significant relationship between E-cadherin expression and OS (p=0.741). Twenty (35%) cases with membranous, 9 (56.2%) cases with cytoplasmic and membranous, and one of the 2 cases with only cytoplasmic staining lost their lives. There was no significant relationship between staining patterns in tumor cells and OS (p=0.550).
Twenty-five patients (41.7%) with beta-catenin overexpression and 13 cases (33.3%) with its downregulation lost their lives. There was no statistically significant relationship between beta- catenin expression and OS (p=0.402). Fourteen (50%) cases with membranous, 21 (33.3%) with cytoplasmic and membranous, and 2 (40%) with only cytoplasmic staining did not survive. There was no statistically significant relationship between staining patterns and OS (p=0.09).
Thirty-five (38.5%) score 1 and 3 (50%) score 2 cases with N-cadherin expression lost their lives. One score 3 case survived. There was no significant relationship between N-cadherin expression and OS (p=0.843). Nine (52.9%) cases with nuclear, 5 (35.7%) cases with cytoplasmic, and 24 (36.4%) cases with negative staining did not survive. One patient with cytoplasmic and membranous staining survived. There was no statistically significant relationship between N-cadherin staining pattern and OS (p=0.467).
Six (66.7%) cases with, and 32 (35.6%) cases without Zeb1 expression in the tumor exited. A significant negative correlation was observed between Zeb1 positivity in the tumor and OS (p=0.006) (Figure 3).
The percentages of Zeb1 positive fibroblasts in the stroma around the tumor were <10% in 5 (26.3%), 11-50% in 17 (36.2%), and >50% in 16 (48.5%) deceased patients. A significant negative correlation was observed between OS and the percentage density increase in Zeb1 positive fibroblasts around the tumor (p=0.008) (Figure 4).
Alpha-SMA expression was not observed in tumor cells. The relationship between the density of αSMA- positive fibroblasts in the surrounding stroma and survival was evaluated. Indicated number of patients with staining densities of ≤ 10% (n=14: 41.2%), 11-50% (n=8: 34.8%), and >50% (n=16: 38%) did not survive. There was no significant correlation between tumor circumference αSMA positive stromal fibroblast density and OS (p=0.66). Both tumoral and stromal Zeb1 expressions were significantly associated with OS in univariate analysis. This significant relationship was also demonstrated by Cox regression analysis (p=0.019, p=0.023) (Table 3).