The tumour–stroma ratio in colon cancer: the biological role and its prognostic impact

Abstract

The tumour microenvironment consists of a complex mixture of non-neoplastic cells, including fibroblasts, immune cells and endothelial cells embedded in the proteins of the extracellular matrix. The tumour microenvironment plays an active role in tumour behaviour. By interacting with cancer cells, it influences disease progression and the metastatic capacity of the tumour. Tumours with a high amount of stroma correspond to poor patient prognosis. The tumour-stroma ratio (TSR) is a strong independent prognostic tool in colon cancer and provides additional value to the current clinically used tumour-node-metastasis classification. The TSR is assessed on conventional haematoxylin and eosin-stained paraffin sections at the invasive front of the tumour. Here we review studies demonstrating the prognostic significance of the TSR in solid epithelial tumours with a focus on colon cancer. Moreover, the biological role of the tumour microenvironment during tumour progression and invasion will be discussed, as well as the attempts to target the tumour stroma for therapeutic purposes. We suggest that the TSR can be implemented with little effort and without additional costs in current routine pathology diagnostics owing to its simplicity and reliability.

Computer aided quantification of intratumoral stroma yields an independent prognosticator in rectal cancer

“…Future work will be directed towards further automation of TSR assessment and validation in a large independent cohort. Although, to the best of our knowledge, TSR assessment (visual or automated) has not yet been implemented in routine pathology diagnostics, it was recently reported [24] that the TNM Evaluation Committee (UICC) and the College of American Pathologists (CAP) have discussed TSR and acknowledged its potential for integration with the TNM staging system. To achieve this for colon cancers, we are currently investigating the reproducibility of (visual) TSR assessment in a large European multicenter study [25].…”

The Relationship Between Tumor Glucose Metabolism and Host Systemic Inflammatory Responses in Patients with Cancer: A Systematic Review

“…In addition to the tumor cells themselves, stromal cells and inflammatory cells are now recognized to play a role in growth and progression of cancer. The predominant cells in the tumor stroma are the cancerassociated fibroblasts that have been shown to promote tumor progression and invasion through the production of growth factors, cytokines, and metabolites and to stimulate blood vessel formation (32). Such stromal cell activity is intimately linked to inflammatory cell activity, and macrophages contribute to tumor progression and spread by the promotion of genetic instability, protection and nurturing of cancer stem cells, promotion of metastatic spread, and the downregulation of the protective T-cell driven adaptive immune response (33)(34)(35).…”

The intra-tumoural stroma in patients with breast cancer increases with age

“…tumour stroma, consists of a variety of structures and cells located in the extracellular matrix, such as immune cells, fibroblasts and endothelial cells. Various processes in the tumour microenvironment are involved in tumour progression by influencing the proliferation of cancer cells, the epithelial-mesenchymal transition, tumour metabolism and dissemination capabilities [3]. Epidemiological and clinicopathological characteristics are different in older patients with breast cancer compared to their younger counterparts [4][5][6][7].…”