Tumor-stroma ratio as prognostic factor for survival in rectal adenocarcinoma: A retrospective cohort study

Abstract

AIMTo evaluate the prognostic value of the tumor-stroma ratio (TSR) in rectal cancer.METHODSTSR was determined on hematoxylin and eosin stained histological sections of 154 patients treated for rectal adenocarcinoma without prior neoadjuvant treatment in the period 1996-2006 by two observers to assess reproducibility. Patients were categorized into three categories: TSR-high [carcinoma percentage (CP) ≥ 70%], TSR-intermediate (CP 40%, 50% and 60%) and TSR-low (CP ≤ 30%). The relation between categorized TSR and survival was analyzed using Cox proportional hazards model.RESULTSThirty-six (23.4%) patients were scored as TSR-low, 70 (45.4%) as TSR-intermediate and 48 (31.2%) as TSR-high. TSR had a good interobserver agreement (κ = 0.724, concordance 82.5%). Overall survival (OS) and disease free survival (DFS) were significantly better for patients with a high TSR (P = 0.01 and P = 0.02, respectively). A similar association existed for disease specific survival (P = 0.06). In multivariate analysis, patients without lymph node metastasis and an intermediate TSR had a higher risk of dying from rectal cancer (HR = 5.27, 95%CI: 1.54-18.10), compared to lymph node metastasis negative patients with a high TSR. This group also had a worse DFS (HR = 6.41, 95%CI: 1.84-22.28). An identical association was seen for OS. These relations were not seen in lymph node metastasis positive patients.CONCLUSIONThe TSR has potential as a prognostic factor for survival in surgically treated rectal cancer patients, especially in lymph node negative cases.

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

“…An existing cohort of 154 patients [8] with rectal adenocarcinoma stages I-III was used. All patients received curative surgery in the period 1996-2006 at the Medisch Spectrum Twente hospital (The Netherlands).…”

“…Generally, TSR is an independent prognostic factor, where a high content of intratumoral stroma is associated with a poor prognosis. A number of previous studies showed promising results on the prognostic relevance of TSR in CRC [8][9][10][11][12]. Despite this evidence, there is no implementation in routine pathology reporting.…”

“…Only a limited number of studies have been published on TSR for rectal cancers and in a sub-analysis (n = 43) by West et al [12] its prognostic value could not be confirmed. Work by Scheer et al [8] recently showed that TSR has potential as a prognostic factor for survival in surgically treated rectal cancer patients, however, TSR was only found to be an independent prognosticator in lymph node metastasis negative cases. The performance of the automated TSR system described here will be compared with data from human experts and its prognostic value will be evaluated in terms of disease-specific and disease-free survival times.…”

The prognostic value of the tumor–stroma ratio is most discriminative in patients with grade III or triple‐negative breast cancer

“…TSR assessment is easy, quick and without additional costs. Previous research demonstrated the prognostic value of the TSR in different types of invasive solid tumors, including breast cancer . Most of these studies validated a worse prognosis for patients with stroma‐high tumors.…”

Gels for Live Analysis of Compartmentalized Environments (GLAnCE): A Tissue Model to Probe Tumour Phenotypes at Tumour-Stroma Interfaces

“…Further, CAFs directly initiate tumour cell invasion by supporting epithelial-to-mesenchymal transitions (21)(22)(23) and by altering the composition and mechanical properties of tumour extracellular matrix (ECM) (24)(25)(26)(27). As a result, patients with tumours characterized by high stromal content carry a worse prognosis in a multitude of solid tumours (28)(29)(30)(31).…”