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In addition to the association with poor prognosis, we discovered a relationship with bowel obstruction. Detailed analysis revealed that clinical findings related to bowel obstruction occurred more frequently in patients with an elevated type tumor, which had peritoneal elastic laminal elevation to the tumor surface, compared to those with non\u2010elevated type tumors among those with elastic laminal invasion (<jats:styled-content style=\"fixed-case\">ELI<\/jats:styled-content>). Lateral tumor spread and increase of tumor annularity rate in <jats:styled-content style=\"fixed-case\">ELI<\/jats:styled-content>\u2010positive elevated type cases suggested the morphological progression from <jats:styled-content style=\"fixed-case\">ELI<\/jats:styled-content>\u2010positive non\u2010elevated type to elevated type. In addition, \u03b1\u2010smooth muscle actin expression was the highest in <jats:styled-content style=\"fixed-case\">ELI<\/jats:styled-content>\u2010positive elevated type, and prominent expressions were found not only in the deep tumor area but also in the shallow tumor area. Furthermore, contraction assays revealed the robust contractile ability of subperitoneal fibroblasts stimulated by cancer cell\u2010conditioned medium. Our findings suggest that <jats:styled-content style=\"fixed-case\">CMPI<\/jats:styled-content> spread into the luminal side of the colonic wall along with tumor progression, which caused bowel obstruction through the activation of subperitoneal fibroblasts. However, although the clinical outcome was not different between the two types, the clinical findings were affected by the spread of <jats:styled-content style=\"fixed-case\">CMPI<\/jats:styled-content>. We are the first to explore how the alteration of the tumor\u2010promoting microenvironment, along with tumor progression, contributes to the development of clinical findings.<\/jats:p>","DOI":"10.1111\/cas.12615","type":"journal-article","created":{"date-parts":[[2015,1,23]],"date-time":"2015-01-23T06:03:56Z","timestamp":1421993036000},"page":"466-474","source":"Crossref","is-referenced-by-count":7,"title":["Spread of tumor microenvironment contributes to colonic obstruction through subperitoneal fibroblast activation in colon cancer"],"prefix":"10.1111","volume":"106","author":[{"given":"Mitsuru","family":"Yokota","sequence":"first","affiliation":[{"name":"Division of Colorectal Surgery Research Center for Innovative Oncology National Cancer Center Hospital East Kashiwa Japan"},{"name":"Department of Surgery School of Medicine Keio University Tokyo 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