Correlation Between Tumor-Associated Collagen Signature and Fibroblast Activation Protein Expression With Prognosis of Clear Cell Renal Cell Carcinoma Patient

BACKGROUND: Despite recent promising findings from immunotherapy and other targeted medicines, individuals with metastatic clear cell renal cell carcinoma (mCCRCC) still have a poor prognosis. Biomarkers associated with metastatic status in CCRCC are important for early detection and for the identification of new therapeutic targets. The expression of fibroblast activation protein (FAP) is associated with the development of early metastases and worse cancer-specific survival. Tumor-associated collagen signature (TACS) is a type of collagen that develops during tumor growth and is associated with tumor invasion. METHODS: Twenty-six mCCRCC patients that underwent nephrectomy were admitted to this study. Data regarding age, sex, Fuhrman’s grade, tumor diameter, staging, FAP expression, and TACS grading were collected. Spearman rho test was used to correlate FAP expression and TACS grading in both primary tumors and metastases and with the patient’s age and sex. RESULTS: FAP manifestation correlated positively with TACS degree (Spearman rho test r = 0.51; P = 0.0001). FAP was positive in 25 (96%) of all intratumor samples and positive in 22 (84%) of all stromal samples. CONCLUSIONS: FAP can be used as a prognostic factor in mCCRCC; its presence can predict the aggressiveness of mCRCC and poorer outcome in the patient. Furthermore, TACS can also be used for the prediction of aggressiveness and metastasis due to the changes necessary for a tumor to invade other organs.