Contrasting Prognostic Roles of Stromal Periostin Expression and Immune Cells Infiltration in Colorectal Carcinoma

Document Type : Research Articles

Authors

1 Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.

2 Department of Medical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.

Abstract

Background and objectives: Colorectal carcinoma (CRC) is one of the most common causes of cancer-related deaths worldwide. The prognosis of CRC patients is variable even within the same cancer stage. The tumor microenvironment (TME) plays a crucial role in CRC, yet its prognostic value remains incompletely understood. We hypothesize that different components of TME can affect patient outcomes in multiple ways. In this study, we assessed the prognostic implications of the desmoplastic reaction (DR) and immune cell infiltration within the TME of CRC through morphological and immunohistochemical (IHC) evaluation. Methods: A retrospective cohort of 65 CRC patients was examined. The patterns of DR and the density of tumor infiltrating lymphocytes (TILs) were evaluated in Hematoxylin and Eosin (H&E)-stained sections. IHC was performed for periostin (POSTN), CD8, CD4, and CD68. Associations with clinicopathological parameters and overall survival (OS), both in the entire study group and in the subgroup treated with adjuvant-therapy were investigated. The relation between different components of TME was also assessed.Results: High stromal POSTN expression correlated significantly with poor prognosis and reduced OS (p=0.005). High density of TILs in H&E-stained slides, CD8⁺, CD4⁺, and combined (CD8+CD4) T-lymphocytes was associated with improved OS (p=0.03, 0.02, p=0.03, and <0.001, respectively), while a high density of CD68+ macrophages was linked to poor prognosis (p=0.006). The combined (CD8+CD4) T-lymphocytes score emerged as an independent prognostic factor for OS (HR=0.1, p<0.001), outperforming the other studied parameters. Conclusion: Stromal POSTN expression and immune cell infiltration, particularly combined (CD8+CD4), offer significant prognostic insights in CRC and may guide therapeutic decisions.

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Asian Pacific Journal of Cancer Prevention
Volume 27, Issue 1
January 2026
Pages 389-398

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History

  • Receive Date: 05 August 2025
  • Revise Date: 22 September 2025
  • Accept Date: 18 January 2026

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