“…This extracellular proteolytic activity encourages the invasion of cancer cells into surrounding tissues, blood and lymphatic vessels, and the metastasis of tumor tissue to distant tissues. Studies have shown that the expression of CTSL signi cantly increases in lung cancer, gastric cancer, ovarian cancer, breast cancer, glioma and other malignant tumors, and it promotes the proliferation, invasion, migration, drug resistance and angiogenesis of tumor cells and other malignant biological behaviors (9,10). Yu et al found that the over-expressed transcription factor Forkhead box O3a (FOXO3a) in gastric cancer cells can increase the activation of the CTSL promoter, inhibit the expression of E-cadherin, and promote gastric cancer (11).…”