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Original Research

Open Access Special Issue

Association of cancer-associated fibroblasts and survival in malignant ovarian neoplasms

  • Ana Carolinne da Silva1
  • Millena Prata Jammal1
  • Renata Margarida Etchebehere2
  • Eddie Fernando Candido Murta1
  • Rosekeila Simões Nomelini1,*,

1Department of Gynecology and Obstetrics/Research Institute of Oncology (IPON), Federal University of Triângulo Mineiro, 38025-440 Uberaba-MG, Brazil

2Surgical Pathology Service, Federal University of Triângulo Mineiro, 38025-440 Uberaba-MG, Brazil

DOI: 10.31083/j.ejgo4204118 Vol.42,Issue 4,August 2021 pp.782-787

Submitted: 18 April 2021 Accepted: 21 June 2021

Published: 15 August 2021

(This article belongs to the Special Issue Immunology in Gynecological Cancer)

*Corresponding Author(s): Rosekeila Simões Nomelini E-mail:;


Objective: The aims of the study were to compare the stromal immunostaining of smooth muscle alpha-actin (α-SMA) and fibroblast activation protein-α (FAP) between borderline ovarian tumors and epithelial ovarian cancer, and to evaluate their association in overall survival (OS) and disease-free survival (DFS) in patients with ovarian cancer. Methods: Patients diagnosed with malignant (n = 28) and borderline ovarian tumors (n = 18) were evaluated. Immunohistochemical study of stromal α-SMA and FAP was carried out. The comparison of immunostaining between borderline and malignant ovarian tumors was performed using Fisher’s exact test. Survival was assessed by the Kaplan-Meier method and the log-rank test. Multivariate analysis was performed by Cox regression. The differences were considered significant for p < 0.05. Results: Evaluating stromal FAP, stronger immunostaining (2 and 3) was more often found in epithelial ovarian cancer than in borderline ovarian tumors (p = 0.0331). There was no statistical significance in the assessment of α-SMA. Evaluating only patients with epithelial ovarian cancer, there was a higher OS in patients with stromal α-SMA immunostaining 3 (p = 0.017). There was no statistical significance when evaluating OS and DFS in patients with stromal FAP immunostaining, nor evaluating DFS in patients with α-SMA stromal immunostaining 3. After multivariate analysis, patients with stromal α-SMA immunostaining 3 had higher OS compared to immunostaining 0, 1 or 2 [OR (95% CI) = 0.107 (0.018–0.649), p = 0.015]. Conclusion: Stronger FAP immunostaining was more often found in epithelial ovarian cancer than in borderline ovarian tumors. In epithelial ovarian cancer, there was a higher OS in patients with stromal α-SMA immunostaining 3.


Epithelial ovarian cancer; Borderline ovarian tumors; Smooth muscle alpha-actin; Fibroblast activation protein-α; Tumor microenvironment; Overall sur-vival

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Ana Carolinne da Silva,Millena Prata Jammal,Renata Margarida Etchebehere,Eddie Fernando Candido Murta,Rosekeila Simões Nomelini. Association of cancer-associated fibroblasts and survival in malignant ovarian neoplasms. European Journal of Gynaecological Oncology. 2021. 42(4);782-787.


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