TY - JOUR
T1 - Tumor-stroma ratio as prognostic factor for survival in rectal adenocarcinoma
T2 - A retrospective cohort study
AU - Scheer, René
AU - Baidoshvili, Alexi
AU - Zoidze, Shorena
AU - Elferink, Marloes A.G.
AU - Berkel, Annefleur E.M.
AU - Klaase, Joost M.
AU - van Diest, Paul J.
N1 - Publisher Copyright:
© The Author(s) 2017.
PY - 2017/12/1
Y1 - 2017/12/1
N2 - AIM: To evaluate the prognostic value of the tumor-stroma ratio (TSR) in rectal cancer. METHODS: TSR 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. RESULTS: Thirty-six (23.4%) patients were scored as TSR-low, 70 (45.4%) as TSR-intermediate and 48 (31.2%) as TSRhigh. 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. CONCLUSION: The TSR has potential as a prognostic factor for survival in surgically treated rectal cancer patients, especially in lymph node negative cases.
AB - AIM: To evaluate the prognostic value of the tumor-stroma ratio (TSR) in rectal cancer. METHODS: TSR 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. RESULTS: Thirty-six (23.4%) patients were scored as TSR-low, 70 (45.4%) as TSR-intermediate and 48 (31.2%) as TSRhigh. 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. CONCLUSION: The TSR has potential as a prognostic factor for survival in surgically treated rectal cancer patients, especially in lymph node negative cases.
KW - Adenocarcinoma
KW - Pathology
KW - Prognosis
KW - Rectal cancer
KW - Recurrence
KW - Tumor-stroma ratio
UR - https://www.scopus.com/pages/publications/85041734441
U2 - 10.4251/wjgo.v9.i12.466
DO - 10.4251/wjgo.v9.i12.466
M3 - Article
C2 - 29290917
SN - 1948-5204
VL - 9
SP - 466
EP - 474
JO - World Journal of Gastrointestinal Oncology
JF - World Journal of Gastrointestinal Oncology
IS - 12
ER -