Prognostic Role of Musashi-2 Immunohistochemical Expression and CD163+ Tumor- Associated Macrophages in Colorectal Cancer Progression

Preoperative assessment of colorectal cancer requires a multimodal approach including clinical, radiographic, biochemical and colonoscopic assessment with histologic review of biopsies that provides valuable information regarding tumor grading and other significant prognostic factors that aid in determination of the appropriate treatment. The association between Musashi-2 expression and clinicopathological features and its prognostic significance in CRC patients is still controversial. Our study is designed to investigate the expression and prognostic significance of MSI2 and CD163+Tumor associated macrophages in colorectal cancer patients. Prospective longitudinal study was designed including 114 CRC cases from Tropical Medicine Department and Oncology Center, Mansoura University Hospitals, during the period from July 2021 to October 2024, all cases were diagnosed by colonoscopy then underwent radical surgery with biopsies which were examined by IHC staining for MSI2 and CD163+TAM using tissue microarray technique trying to find out their correlation with clinicopathological parameters and patients prognosis. Among 114 CRC cases, high MSI2 expression was detected in 49 (43%). MSI2 expression was significantly related to grade of differentiation (P = 0.001*), depth of invasion (P = 0.001*), lymph node metastasis (P = 0.001*), TNM stage (P = 0.001*) and hepatic metastasis (P = 0.009*). Multivariate analysis spotted MSI2 expression as a predictor for Overall survival in CRC (P = 0.015*) and disease free survival (P = 0.008*). CD163+TAM showed a significant correlation to grade of differentiation (P = 0.001*), depth of invasion (P = 0.05*), lymph node metastasis (P = 0.001*), TNM stage (P = 0.001*), and hepatic metastasis (P = 0.007*). Multivariate analysis spotted CD163+TAM expression as a predictor for OS in CRC (P = 0.037*) and DFS (P = 0.003*). MSI2 and CD163+TAM are independent prognostic factors for the overall survival and disease free survival and can predict poor prognosis in CRC patients.