title: Prognostic significance of matrix metalloproteinase-9 (MMP-9) in epithelial ovarian cancer.
abstract: OBJECTIVE
  We investigated the expression of matrix metalloproteinase-9 (MMP-9) and its relation to clinicopathologic factors and survival and also to previously analyzed expressions of CD44 and hyaluronan in epithelial ovarian cancer.
  
  
  METHODS
  The expression of MMP-9 was analyzed immunohistochemically in 292 primary tumors and their 31 metastases.
  
  
  RESULTS
  A low proportion of strong MMP-9 expression in cancer cells and high stromal MMP-9 expression correlated with advanced stage of the tumor (p=0.003, p=0.02, respectively). Stromal MMP-9 expression significantly correlated with hyaluronan positivity (p<0.0005), whereas MMP-9 did not correlate with CD44. In univariate analysis, a longer 10-year disease-related survival (DRS) was found in patients with a high proportion of MMP-9 or strong MMP-9 expression in cancer cells (p=0.02, p=0.05, respectively). However, high stromal expression of MMP-9 indicated short DRS (p=0.01). In multivariate analysis of all patients, MMP-9 expressing cancer or stromal cells were not independent prognostic factors, while in FIGO stage I patients a high percentage of MMP-9 positive cancer cells was associated with long DRS (p=0.008).
  
  
  CONCLUSIONS
  These data suggest that MMP-9 has a dual role in tumor progression, acting against tumor advancement when in tumor epithelium and promoting tumor progression while in the stroma.
authors.affiliation: Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Kuopio, and Department of Clinical Pathology, Kuopio University Hospital, Finland.
authors.forename: S
authors.initials: S
authors.lastname: Sillanpää
authors.forename: M
authors.initials: M
authors.lastname: Anttila
authors.forename: K
authors.initials: K
authors.lastname: Voutilainen
authors.forename: K
authors.initials: K
authors.lastname: Ropponen
authors.forename: T
authors.initials: T
authors.lastname: Turpeenniemi-Hujanen
authors.forename: U
authors.initials: U
authors.lastname: Puistola
authors.forename: R
authors.initials: R
authors.lastname: Tammi
authors.forename: M
authors.initials: M
authors.lastname: Tammi
authors.forename: R
authors.initials: R
authors.lastname: Sironen
authors.forename: S
authors.initials: S
authors.lastname: Saarikoski
authors.forename: V-M
authors.initials: VM
authors.lastname: Kosma
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D006801:Humans; D018960:Hyaluronan Receptors / Q000096:biosynthesis; D006820:Hyaluronic Acid / Q000096:biosynthesis; D007150:Immunohistochemistry; D020780:Matrix Metalloproteinase 9 / Q000096:biosynthesis*; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000201:enzymology* / Q000473:pathology; D011379:Prognosis; D016896:Treatment Outcome
chemical_list: C497483:CD44 protein, human; D018960:Hyaluronan Receptors; D006820:Hyaluronic Acid; D020780:Matrix Metalloproteinase 9