Heterogeneous distribution of Fusobacterium nucleatum in the progression of colorectal cancer

BACKGROUND AND AIM Fusobacterium nucleatum (Fn) is involved in colorectal cancer (CRC) growth and is a biomarker for patient prognosis and management. However, the ecology of Fn in CRC and the distribution of intratumoral Fn are unknown. METHODS We evaluated Fn, and the status of KRAS and BRAF in 200 colorectal neoplasms (118 adenomas and 82 cancers) and 149 matched adjacent normal mucosas. The differentiation status between "surface" and "deep" areas of cancer tissue and matched normal mucosa were analyzed in 46 surgical samples; the Ki-67 index was also evaluated in these samples. RESULTS Fn presence in the tumor increased according to pathological stage: 5.9% (adenoma) to 81.8% (stage III/IV), while Fn presence in normal mucosa also increased: 7.6% (adenoma) to 40.9% (stage III/IV). The detection rates of Fn on the tumor surface and in deep areas were 45.7% and 32.6%, while that of normal mucosa was 26.1% and 23.9%, respectively. Stage III/IV tumors showed high Fn surface area expression (66.7%). Fn intratumoral heterogeneity (34.8%) was higher than that of KRAS (4.3%; p < 0.001) and BRAF (2.2%; p < 0.001). The Ki-67 index in Fn-positive cases was higher than that in negative cases (93.9% vs. 89.0%; p = 0.01). CONCLUSIONS Fn was strongly present in CRC superficial areas at stage III/IV. The presence of Fn in the deep areas of adjacent normal mucosa also increased. The intratumoral heterogeneity of Fn is important in the use of Fn as a biomarker, as Fn is associated with CRC proliferative capacity.