SMO Expression in Colorectal Cancer: Associations with Clinical, Pathological, and Molecular Features

Tingting Li, Xiaoyun Liao, Paul Lochhead, Teppei Morikawa, Mai Yamauchi, Reiko Nishihara, Kentaro Inamura, Sun A Kim, Kosuke Mima, Yasutaka Sukawa, Aya Kuchiba, Yu Imamura, Yoshifumi Baba, Kaori Shima, Jeffrey A Meyerhardt, Andrew T Chan, Charles S Fuchs, Shuji Ogino, Zhi Rong Qian

Research output: Contribution to journalArticlepeer-review

27 Citations (Scopus)


BACKGROUND: Smoothened, frizzled family receptor (SMO) is an important component of the hedgehog signaling pathway, which has been implicated in various human carcinomas. However, clinical, molecular, and prognostic associations of SMO expression in colorectal cancer remain unclear.

METHODS: Using a database of 735 colon and rectal cancers in the Nurse's Health Study and the Health Professionals Follow-up Study, we examined the relationship of tumor SMO expression (assessed by immunohistochemistry) to prognosis, and to clinical, pathological, and tumor molecular features, including mutations of KRAS, BRAF, and PIK3CA, microsatellite instability, CpG island methylator phenotype (CIMP), LINE-1 methylation, and expression of phosphorylated AKT and CTNNB1.

RESULTS: SMO expression was detected in 370 tumors (50 %). In multivariate logistic regression analysis, SMO expression was independently inversely associated with phosphorylated AKT expression [odds ratio (OR) 0.48; 95 % confidence interval (CI) 0.34-0.67] and CTNNB1 nuclear localization (OR 0.48; 95 % CI 0.35-0.67). SMO expression was not significantly associated with colorectal cancer-specific or overall survival. However, in CIMP-high tumors, but not CIMP-low/0 tumors, SMO expression was significantly associated with better colorectal cancer-specific survival (log-rank P = 0.012; multivariate hazard ratio, 0.36; 95 % CI 0.13-0.95; P interaction = 0.035, for SMO and CIMP status).

CONCLUSIONS: Our data reveal novel potential associations between the hedgehog, the WNT/CTNNB1, and the PI3K (phosphatidylinositol-4,5-bisphosphonate 3-kinase)/AKT pathways, supporting pivotal roles of SMO and hedgehog signaling in pathway networking. SMO expression in colorectal cancer may interact with tumor CIMP status to affect patient prognosis, although confirmation by future studies is needed.

Original languageEnglish
Pages (from-to)4164-4173
Number of pages10
JournalAnnals of Surgical Oncology
Issue number13
Early online date15 Jul 2014
Publication statusPublished - Dec 2014


  • surgical oncology
  • oncology
  • surgery


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