Background
Epithelial to mesenchymal transition (EMT) is a key process in determining distant metastasis and intra-hepatic dissemination of hepatocellular carcinoma (HCC). Follistatin (
FST
) family members are considered to be an attractive therapeutic targets and prognostic indicators in cancers. As a derivative of
FST
, Follistatin Like 5 (
FSTL5
) may play a similar role in HCC cells. This study aimed to investigate the expression and function of
FSTL5
in HCC and its role in EMT.
Methods
FSTL5
, E-cadherin and vimentin in HCC, and paracancerous tissues were detected by immunohistochemistry. Correlation of
FSTL5
expression with overall survival was assessed. The proliferation and invasion of HCC cell lines SK-Hep1 and MHCC-LM3 were analyzed by cell counting kit-8 and Transwell assays. The expression of
FSTL5
, E-cadherin, and vimentin in HCC cells was examined by polymerase chain reaction and Western blot analysis.
T
-test was used to analyze the difference in proliferation and invasion ability between groups. The Spearman rank correlation test was used to detect the correlation between the expression of
FSTL5
and E-cadherin or vimentin.
Results
The expression of
FSTL5
in HCC was lower than that in paracancerous tissues (9.97%
vs
. 82.55%,
χ
2
= 340.15,
P
<
0.001). Patients with high
FSTL5
expression had a better prognosis (
χ
2
= 8.22,
P
= 0.004) and smaller tumor diameter (
χ
2
= 45.52,
P
<
0.001), less lymph node metastasis (
χ
2
= 5.58,
P
=
0.02), earlier tumor node metastasis stage (
χ
2
= 11.29,
P
= 0.001), a reduced number of tumors (
χ
2
= 5.05,
P
= 0.02), lower alpha-fetoprotein value (
χ
2
= 24.36,
P
<
0.001), more probability of hepatitis carrying (
χ
2
= 40.9,
P
<
0.001), and better liver function grade (
χ
2
= 5.21,
P
= 0.02). Immunohistochemistry showed that
FSTL5
expression in HCC tissues was positively correlated with E-cadherin expression (
r
= 0.38,
...