Association and Prognostic Significance of Alpha-L-fucosidase-1 and Matrix Metalloproteinase 9 Expression in Esophageal Squamous Cell Carcinoma

Background: Alpha-L-fucosidase-1 (FUCA1) has been demonstrated to play opposing regulatory roles in adenocarcinoma and non-adenocarcinoma. Moreover, recent studies reported that FUCA1 could decrease the invasion capability by downregulating matrix metalloproteinase 9 (MMP-9) expression. However, the potential role and prognostic significance of FUCA1 in esophageal squamous cell carcinoma (ESCC) have not yet been explored.

Aim: To evaluate the status, association, and prognostic value of FUCA1 and MMP-9 expression in ESCC.

Methods: Patients who underwent esophagectomy for ESCC between January 1, 2014, and December 31, 2014 at Sun Yat-Sen University Cancer Center were enrolled. The expression status of FUCA1 and MMP-9 in cancerous tissues was detected using immunohistochemistry. In addition, the expression profiles of the and genes in non-metastatic ESCC were extracted from The Cancer Genome Atlas (TCGA) database.

Results: High expression of FUCA1 and MMP-9 was found in 90 patients (75.6%) and 62 patients (52.1%), respectively. In the high FUCA1 expression group, the constituent ratios of patients with stage III disease (61.1% 37.9%, = 0.029), lymphatic invasion (62.2% 31.0%, = 0.003), and high MMP-9 expression (60.0% 27.6%, = 0.002) were significantly higher than those in the low FUCA1 expression group. In Kaplan-Meier univariate analysis, advanced tumor-node-metastasis stage (III, = 0.001), positive regional lymph node metastasis (N+, = 0.002), high FUCA1 expression ( = 0.001), and high MMP-9 expression ( = 0.002) were potential predictors of shorter overall survival (OS), which was similar to the results analyzed based on the TCGA database. Further Cox multivariate regression analyses still demonstrated that FUCA1 and MMP-9 expression levels were independent prognostic factors of OS [hazard ratio (HR): 0.484, 95% confidence interval (CI): 0.239-0.979; = 0.044; and HR: 0.591, 95%CI: 0.359-0.973, = 0.039, respectively].

Conclusion: FUCA1 cooperation with MMP-9 may have a major role in affecting the ESCC invasion and metastatic capability, and serve as a valuable prognostic biomarker in ESCC.