Scheer R, Baidoshvili A, Zoidze S, Elferink MAG, Berkel AEM, Klaase JM, van Diest PJ. Tumor-stroma ratio as prognostic factor for survival in rectal adenocarcinoma: A retrospective cohort study. World J Gastrointest Oncol 2017; 9(12): 466-474 [PMID: 29290917 DOI: 10.4251/wjgo.v9.i12.466]
Corresponding Author of This Article
Joost M Klaase, MD, PhD, Surgical-Oncologist, Department of Surgery, Medisch Spectrum Twente, PO Box 50.000, Enschede 7500 KA, The Netherlands. j.klaase@mst.nl
Research Domain of This Article
Oncology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Dec 15, 2017; 9(12): 466-474 Published online Dec 15, 2017. doi: 10.4251/wjgo.v9.i12.466
Tumor-stroma ratio as prognostic factor for survival in rectal adenocarcinoma: A retrospective cohort study
René Scheer, Alexi Baidoshvili, Shorena Zoidze, Marloes A G Elferink, Annefleur E M Berkel, Joost M Klaase, Paul J van Diest
René Scheer, Annefleur E M Berkel, Joost M Klaase, Department of Surgery, Medisch Spectrum Twente, Enschede 7500 KA, The Netherlands
Alexi Baidoshvili, Shorena Zoidze, Laboratory for Pathology East-Netherlands, Hengelo 7550 AM, The Netherlands
Marloes A G Elferink, Netherlands Comprehensive Cancer Organization, Location Enschede, Enschede 7511 JP, The Netherlands
Paul J van Diest, Department of Pathology, University Medical Center Utrecht, Utrecht 3508 GA, The Netherlands
Author contributions: Scheer R and Klaase JM designed the research; Scheer R and Zoidze S performed the research; Baidoshvili A supervised the histological scoring and took final decisions in case of discrepancy in scores between Scheer R and Zoidze S; Elferink MAG collected data from the population-based The Netherlands Cancer Registy and analyzed the data; Berkel AEM, Klaase JM and van Diest PJ supervised and interpreted the results; Scheer R and Zoidze S wrote the paper; all authors critically reviewed and accepted the final version of the manuscript.
Institutional review board statement: The requirement for informed consent and ethical approval was waived because of the retrospective study design. The study is conducted in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines.
Conflict-of-interest statement: The authors declare no conflict of interests.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at j.klaase@mst.nl. Participants’ informed consent was not obtained, but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Joost M Klaase, MD, PhD, Surgical-Oncologist, Department of Surgery, Medisch Spectrum Twente, PO Box 50.000, Enschede 7500 KA, The Netherlands. j.klaase@mst.nl
Telephone: +31-53-4873441 Fax: +31-53-4872526
Received: June 22, 2017 Peer-review started: July 14, 2017 First decision: August 7, 2017 Revised: September 17, 2017 Accepted: October 15, 2017 Article in press: October 15, 2017 Published online: December 15, 2017 Processing time: 154 Days and 7.6 Hours
Abstract
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 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.
CONCLUSION
The TSR has potential as a prognostic factor for survival in surgically treated rectal cancer patients, especially in lymph node negative cases.
Core tip: The tumor-stroma ratio (TSR) can be determined accurately on routine histopathological sections by different observers. The TSR has potential as a prognostic factor for survival in surgically treated rectal cancer patients, especially in lymph node negative cases. It could therefore be useful in decision making regarding adjuvant treatment in individual patients.
