Angiopoietin-like Protein 2 Expression Is Associated With Host Wasting-Related Poor Prognosis in Colorectal Cancer

Tumor-induced host wasting marked by malnutrition, systemic inflammation, or altered body composition is associated with poor prognosis in cancer patients. Tumor cell-derived angiopoietin-like protein 2 (ANGPTL2) reportedly functions as a tumor promoter in some cancer contexts. This study aims to assess whether ANGPTL2 expression in tumor cells is associated with host wasting in patients with colorectal cancer.

We retrospectively enrolled 88 patients with all-stage colorectal cancer who underwent surgical resection of the primary tumor between January 2017 and December 2017 in a single institution. Based on immunohistochemistry staining, we assessed ANGPTL2 expression in tumor cells in paraffin-embedded tumor samples from resected specimens. The association of the ANGPTL2 expression with clinicopathological factors, biomarkers of host wasting, and survival were analyzed.

Host wasting was associated with significantly high other causes-mortality rates in ANGPTL2-high patients (P = 0.0261) but not in ANGPTL2-low patients (P = 0.4719), suggesting that ANGPTL2 expression in colorectal cancer cells is associated with host wasting-related poor prognosis. Furthermore, ANGPTL2 expression in tumor cells was correlated with the advanced lung cancer inflammation index, which is a biomarker of host wasting (ρ = -0.3119, P = 0.0031).

ANGPTL2 is associated with host wasting-related poor prognosis through its association with systemic inflammation in patients with colorectal cancer. These findings overall provide novel insight into ANGPTL2 function and illustrate the essential role of tumor-host interactions in the prognosis of cancer survivors.