The value of tumor-stroma ratio as predictor of pathologic response after neoadjuvant chemoradiotherapy in esophageal cancer

Pelt, Gabi W. van; Krol, Janna; Lips, Irene M.; Peters, Femke P.; Klaveren, David van; Boonstra, Jurjen J.; Steur, Wobbe O. de; Tollenaar, Rob A.E.M.; Sarasqueta, Arantza Farina; Mesker, Wilma E.; Slingerland, Marije

doi:10.1016/j.ctro.2019.11.003

Cited by 23 publications

(36 citation statements)

References 38 publications

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“…Our study evaluated TSR on preoperative diagnostic biopsy sections of rectal cancer. Likewise, in digestive tract tumours, the results of oesophageal cancer research are consistent with our research [ 7 , 15 ]. They found that the TSR can predict the response to nCRT in oesophageal cancer patients, but they assessed the TSR in artificially selected areas by visually subjective semi-quantitative scoring (10, 20%, ..., 100%).…”

Section: Discussionsupporting

confidence: 92%

“…Our study adopted a full quantification method on WSIs in LARC patients. Compared with the results from Pelt et al (Kappa = 0.73) [ 7 ], our method achieved a higher degree of agreement for TSR evaluation (ICC = 0.99). Furthermore, the multivariate analysis uncovered that only the TSR, neoadjuvant radiotherapy dose and FOLFOX regimen were independent predictive factors.…”

Section: Discussioncontrasting

confidence: 57%

“…Currently, it has become increasingly known that the composition of the tumour microenvironment as well as tumour-stroma interactions play a major role in tumour progression, metastasis, and therapy resistance, leading to poor clinical outcomes [ 7 ]. The stroma is one of the key components in the tumour microenvironment.…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, there have been different studies that found that the tumour-stroma ratio (TSR) is a valid and practical prognostic factor in solid tumours, including oesophageal cancer, endometrial carcinoma, non-small-cell lung cancer, and CRC [ 11 – 14 ]. Most studies have evaluated the TSR on surgical paraffin sections, while only a few studies have evaluated this parameter on biopsy specimens [ 7 , 15 ]. A retrospective study from Pelt et al investigated the value of TSR based on biopsy specimen assessment to predict nCRT response in patients with oesophageal cancer [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Most studies have evaluated the TSR on surgical paraffin sections, while only a few studies have evaluated this parameter on biopsy specimens [ 7 , 15 ]. A retrospective study from Pelt et al investigated the value of TSR based on biopsy specimen assessment to predict nCRT response in patients with oesophageal cancer [ 7 ]. However, a subjective method was used in their study to evaluate the TSR, with disagreement among pathologists.…”

Section: Introductionmentioning

confidence: 99%

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The value of the tumour-stroma ratio for predicting neoadjuvant chemoradiotherapy response in locally advanced rectal cancer: a case control study

et al. 2021

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Background The tumour-stroma ratio (TSR) is recognized as a practical prognostic factor in colorectal cancer. However, TSR assessment generally utilizes surgical specimens. This study aims to investigate whether the TSR evaluated from preoperative biopsy specimens by a semi-automatic quantification method can predict the response after neoadjuvant chemoradiotherapy (nCRT) of patients with locally advanced rectal cancer (LARC). Methods A total of 248 consecutive patients diagnosed with LARC and treated with nCRT followed by resection were included. Haematoxylin and eosin (HE)-stained sections of biopsy specimens were collected, and the TSR was evaluated by a semi-automatic quantification method and was divided into three categories, using the cut-offs determined in the whole cohort to balance the proportion of patients in each category. The response to nCRT was evaluated on the primary tumour resection specimen by an expert pathologist using the four-tier tumour regression grade (TRG) system. Results The TSR can discriminate patients that are major-responders (TRG 0–1) from patients that are non-responders (TRG 2–3). Patients were divided into stroma-low (33.5%), stroma-intermediate (33.9%), and stroma-high (32.7%) groups using 56.3 and 72.8% as the cutoffs. In the stroma-low group, 58 (69.9%) patients were major-responders, and only 39 (48.1%) patients were considered major-responders in the stroma-high group (P = 0.018). Multivariate analysis showed that the TSR was the only pre-treatment predictor of response to nCRT (adjusted odds ratio 0.40, 95% confidence interval 0.21–0.76, P = 0.002). Conclusion An elevated TSR in preoperative biopsy specimens is an independent predictor of nCRT response in LARC. This semi-automatic quantified TSR could be easily translated into routine pathologic assessment due to its reproducibility and reliability.

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Section: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The value of the tumour-stroma ratio for predicting neoadjuvant chemoradiotherapy response in locally advanced rectal cancer: a case control study

et al. 2021

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Tumor Microenvironment‐Based Risk Stratification of Oropharyngeal Squamous Cell Carcinoma

Almangush,

Jouhi,

Haglund

et al. 2024

Head & Neck

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BackgroundEvaluation of the prognostic impact of tumor microenvironment (TME) has received attention in recent years. We introduce a TME‐based risk stratification for oropharyngeal squamous cell carcinoma (OPSCC).Material and MethodsA total of 182 patients treated for OPSCC at the Helsinki University Hospital were included. TME‐based risk stratification was designed combining tumor‐stroma ratio and stromal tumor‐infiltrating lymphocytes assessed in hematoxylin and eosin‐stained sections.ResultsIn multivariable analysis, TME‐based risk stratification associated with poor disease‐free survival with a hazard ratio (HR) of 2.68 (95% CI 1.11–6.48, p = 0.029). In addition, the proposed risk stratification was associated with poor disease‐specific survival (HR 2.687, 95% CI 1.28–5.66, p = 0.009) and poor overall survival (HR 2.21, 95% CI 1.23–3.99, p = 0.008).ConclusionOur TME‐based risk stratification provides a powerful prognostic tool that can be used in daily treatment planning of OPSCC together with tumor‐related prognostic markers.

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Tumor‐stroma ratio is associated with Miller‐Payne score and pathological response to neoadjuvant chemotherapy in HER2‐negative early breast cancer

Hagenaars

Groot

Cohen

et al. 2021

Intl Journal of Cancer

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The tumor-stroma ratio (TSR) has proven to be a strong prognostic factor in breast cancer, demonstrating better survival for patients with stroma-low tumors. Since the role of the TSR as a predictive marker for neoadjuvant chemotherapy outcome is yet unknown, this association was evaluated for HER2-negative breast cancer in the prospective DIRECT and NEOZOTAC trials. The TSR was assessed on 375 hematoxylin and eosinstained sections of pre-treatment biopsies. Associations between the TSR and chemotherapy response according to the Miller-Payne (MP) grading system, and between the TSR and pathological response were examined using Pearson's chi-square, Cochran-Armitage test for trend and regression analyses. A stroma-low tumor prior to neoadjuvant chemotherapy was significantly associated with a higher MP score (P = .005). This relationship remained significant in the estrogen receptor (ER)-negative subgroup (P = .047). The univariable odds ratio (OR) of a stroma-low tumor on pathological complete response (pCR) was 2.46 (95% CI 1.34-4.51, P = .004), which attenuated to 1.90 (95% CI 0.85-4.25, P = .119) after adjustment for relevant prognostic factors. Subgroup analyses revealed an OR of 5.91 in univariable analyses for ER-negativity (95% CI 1.19-29.48, P = .030) and 1.48 for ER-positivity (95% CI 0.73-3.01, P = .281). In conclusion, a low amount of stroma on pre-treatment biopsies is associated with a higher MP score and pCR rate. Therefore, the TSR is a promising biomarker in predicting neoadjuvant treatment outcome. Incorporating this parameter in routine pathological diagnostics could be worthwhile to prevent overtreatment and undertreatment.

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The value of tumor-stroma ratio as predictor of pathologic response after neoadjuvant chemoradiotherapy in esophageal cancer

Abstract: HighlightsScoring the tumor-stroma ratio is a simple and reproducible method.Tumor-stroma ratio and response to neoadjuvant chemoradiotherapy are correlated.Stroma-low tumors are likely to respond better to neoadjuvant chemoradiotherapy.

Cited by 23 publications

References 38 publications

The value of the tumour-stroma ratio for predicting neoadjuvant chemoradiotherapy response in locally advanced rectal cancer: a case control study

The value of the tumour-stroma ratio for predicting neoadjuvant chemoradiotherapy response in locally advanced rectal cancer: a case control study

Tumor Microenvironment‐Based Risk Stratification of Oropharyngeal Squamous Cell Carcinoma

Tumor‐stroma ratio is associated with Miller‐Payne score and pathological response to neoadjuvant chemotherapy in HER2‐negative early breast cancer

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