Extracellular matrix protein 1 in cancer: multifaceted roles in tumor progression, prognosis, and therapeutic targeting.

Extracellular matrix protein 1 (ECM1) is a multifunctional glycosylated protein associated with the cell membrane. Increasing evidence indicates that aberrant ECM1 expression in cancer cells promotes tumor growth and metastasis by regulating proliferation, invasion, migration, and drug resistance. Beyond its direct effects on cancer cells, ECM1 plays a pivotal role in shaping the tumor microenvironment by contributing to angiogenesis, inflammatory responses, and the activation of cancer-associated fibroblasts, which collectively drive malignant progression. Immunohistochemical studies have demonstrated that ECM1 is highly expressed in a wide range of invasive cancers compared with adjacent normal tissues, underscoring its potential as a diagnostic and prognostic biomarker. Moreover, elevated ECM1 expression is consistently associated with poor clinical outcomes across multiple malignancies. In this review, we comprehensively summarize research from the past decade on the role of ECM1 in cancer progression, evaluate its potential as a prognostic biomarker, and highlight recent advances in ECM1-targeted therapeutic strategies. Overall, this review provides new insights into the multifaceted roles of ECM1 in cancer biology and its promise as a molecular target for innovative cancer therapies.