Prognostic Value of Tumor-Stroma Ratio in Rectal Cancer: A Systematic Review and Meta-analysis

Abstract

BackgroundTumor-stroma ratio (TSR) is a promising new prognostic predictor for patients with rectal cancer (RC). Although several studies focused on this pathologic feature, results from those studies were still inconsistent.MethodsThis research aimed to estimate the prognostic values of TSR for RC. A search of PubMed, EMBASE, and Web of Science was carried out. A meta-analysis was performed on disease-free survival, cancer-specific survival, and overall survival in patients with RC.ResultsThe literature search generated 1,072 possible studies, of which a total of 15 studies, involving a total of 5,408 patients, were eventually included in the meta-analysis. Thirteen of the 15 articles set the cutoff for the ratio of stroma at 50%, dividing patients into low-stroma and high-stroma groups. Low TSR (rich-stroma) was significantly associated with poorer survival outcome. (DFS: HR 1.54, 95% CI 1.32–1.79; OS: HR 1.52 95% CI 1.34–1.73; CSS: HR 2.05 95% CI 1.52–2.77).ConclusionPresent data support TSR to be a risk predictor for poor prognosis in RC patients.

Intratumoral Budding in Pretreatment Biopsies, among Tumor Microenvironmental Components, Can Predict Prognosis and Neoadjuvant Therapy Response in Colorectal Adenocarcinoma

“…ITB [ 5 , 13 ], immature DR [ 19 , 20 , 21 ], TSR [ 18 ], and KM grade [ 14 , 15 , 16 ] were originally designed to evaluate the invasive front of radical specimens. However, the biopsy samples usually do not include the invasive margin.…”

“…We evaluated the TSR in PBSs in the same way as we did the KM grade, which is scanning the all fields then selecting hot spot. The TSR is dichotomized into low (≤50% stroma) and high (>50% stroma) types [ 16 , 18 ] ( Figure 1 ).…”

“…Among the TME factors, tumor budding (TB) [ 5 , 6 , 7 , 8 ], cancer-associated fibroblasts [ 9 ], tumor-infiltrating immune cells [ 10 , 11 , 12 ], and tumor endothelial cells [ 4 , 12 ] are prognostic markers of various solid cancers. In addition, some factors, such as TB [ 5 , 13 ], peritumoral inflammation [ 14 , 15 , 16 , 17 ], and the degree [ 15 , 16 , 18 ] or features [ 19 , 20 , 21 ] of fibrosis, are measurable without additional immunohistochemistry, as semi-quantitative or three-tier scoring systems have been developed. In particular, the detection of TB in pretreatment biopsy samples (PBSs), that is, intratumoral budding (ITB) [ 22 , 23 , 24 , 25 , 26 , 27 ] and CD8-positive T cells [ 26 , 27 ], has been proposed as a predictor of prognosis and/or response to neoadjuvant therapy.…”

“…In addition, we classified the type of desmoplastic reaction (DR) as mature, intermediate, or immature [ 19 , 20 , 21 ]. Finally, we investigated inflammation based on the Klintrup–Mäkinen (KM) grade [ 14 , 15 , 16 ], and fibrosis was quantified using the tumor–stroma ratio (TSR) [ 18 ].…”

Tumor-stroma ratio as a new prognosticator for pseudomyxoma peritonei: a comprehensive clinicopathological and immunohistochemical study

“…The tumor-stroma ratio (TSR) reflects the area of tumor and stromal cells and is determined by histopathological sections stained with hematoxylin and eosin (HE). Currently, TSR has been proven to impact the prognosis of esophageal squamous carcinoma, lung cancer, breast cancer, gastric cancer, and other malignant solid tumors [ 6 , 7 ]. This study analyzed the relationship between TSR and the histopathological and immunohistochemical characteristics of PMP and investigated the impact of TSR on PMP prognosis.…”