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

Table 1 Patient characteristics by categorized tumor-stroma ratio

	TSR-low (n = 36)		TSR-intermediate (n = 70)		TSR-high (n = 48)		P-value1
	n	%	n	%	n	%
Gender							NS
Male	24	66.7	44	62.9	32	66.7
Female	12	33.3	26	37.1	16	33.3
Age (yr)	M 68.0	SD 8.0	M 67.3	SD 10.3	M 65.7	SD 10.3	NS2
	(range 49.0-82.0 )		(range 40.0-87.0)		(range 43.0-91.0)
Treatment							NS
APR	19	52.6	31	44.3	17	35.4
LAR	11	30.6	28	40.0	24	50.0
Hartmann	6	16.7	11	15.7	7	14.6
T-status							NS
pT1	1	2.8	1	1.4	4	8.3
pT2	9	25.0	23	32.9	18	37.5
pT3	24	66.7	43	61.4	25	52.1
pT4	2	5.6	3	4.3	1	2.1
N-status							0.029
pN0	16	44.4	44	62.9	34	70.8
N1	15	41.7	13	18.6	11	22.9
N2	5	13.9	13	18.6	3	6.3
Stage							NS
I	7	19.4	21	30.0	17	35.4
II	9	25.0	23	32.9	17	35.4
III	20	55.6	26	37.1	14	29.2
Grading							NS
Well	0	0	1	1.4	3	6.3
Moderate	31	86.1	58	82.9	40	83.3
Poor	5	13.9	11	15.7	5	10.4
Adjuvant treatment	19	52.8	21	30.0	11	22.9	0.0123
Radiotherapy	17		18		9
Chemoradiotherapy	1		3		2
Chemotherapy	1		-		-

¹Pearson χ² test;

²One-Way ANOVA;

³P-value for adjuvant treatment in general. Significant P-values are shown bold. n: Number of patients; %: Percentage; Age defined as period from birth until date of primary surgery; LAR: Low anterior resection; APR: Abdominoperineal resection; pT: Pathological tumor status; pN: Pathological nodal status; Stage according to UICC/AJCC TNM staging system, 5^th edition; TSR: Tumor-stroma ratio; UICC/AJCC: Union Internationale Contre le Cancer/American Joint Cancer Committee.

Table 2 Cox multivariate analysis for overall survival

	N0		N+
	HR	95%CI	HR	95%CI
Age
< 70 yr	1	Ref.	1	Ref.
> 70 yr	3.32a	1.75-6.28	2.26a	1.10-4.65
Grading
Poor	1	Ref.	1	Ref.
Moderate	1.03	0.43-2.49	0.52	0.25-1.10
Well	0.36	0.04-2.99	0.56	0.06-5.31
Adjuvant treatment
No	1	Ref.	1	Ref.
Yes	0.47	0.06-3.50	0.66	0.27-1.60
TSR
TSR-high	1	Ref.	1	Ref.
TSR-intermediate	2.04	0.99-4.21	1.19	0.50-2.84
TSR-low	1.43	0.57-3.60	1.04	0.40-2.69

^aP < 0.05. Age defined as period from birth until date of primary surgery. N0: Lymph node metastasis negative patients; N+: Lymph node metastasis positive patients; TSR: Tumor-stroma ratio.

Table 3 Cox multivariate analysis for disease free survival

	N0		N+
	HR	95%CI	HR	95%CI
Age
< 70 yr	1.00	Ref.	1.00	Ref.
> 70 yr	0.36	0.13-1.01	0.89	0.36-2.22
pT-status
T1	1.00	Ref.	1.00	Ref.
T2	0.11	0.01-1.21	0.66	0.10-4.44
T3	0.85	0.09-7.58	1.51	0.31-7.30
T4	1.61	0.07-39.27	1
Grading
Poor	1.00	Ref.	1.00	Ref.
Moderate	1.43	0.29-6.99	0.58	0.25-1.35
Well	1		1
Adjuvant treatment
No	1.00	Ref.	1.00	Ref.
Yes	0.2	0.01-2.57	1.04	0.32-3.41
TSR
TSR-high	1.00	Ref.	1.00	Ref.
TSR-intermediate	6.41a	1.84-22.28	1.31	0.49-3.51
TSR-low	3.7	0.84-16.42	0.93	0.31-2.74

^aP < 0.05;

¹Too small numbers to analyze. Age defined as period from birth until date of primary surgery. N0: Lymph node metastasis negative patients; N+: Lymph node metastasis positive patients; pT: Pathological tumor status; TSR: Tumor-stroma ratio.

Table 4 Cox multivariate analysis for disease specific survival

	N0		N+
	HR	95%CI	HR	95%CI
Age
< 70 yr	1.00	Ref.	1.00	Ref.
> 70 yr	0.47	0.16-1.40	1.19	0.53-2.67
pT-status
T1	1.00	Ref.	1.00	Ref.
T2	0.12	0.01-1.29	0.48	0.06-3.50
T3	0.69	0.08-6.25	1.29	0.27-6.07
T4	0.46	0.02-8.70	1
Grading
Poor	1.00	Ref.	1.00	Ref.
Moderate	1.03	0.20-5.30	0.46	0.21-1.04
Well	1		1
Adjuvant treatment
No	1.00	Ref.	1.00	Ref.
Yes	0.2	0.01-2.57	1.04	0.32-3.41
TSR
TSR-high	1.00	Ref.	1.00	Ref.
TSR-intermediate	5.27a	1.54-18.1	1.60	0.54-4.70
TSR-low	3.48	0.78-15.55	1.22	0.41-3.66

^aP < 0.05;

¹Too small numbers to analyze. Age defined as period from birth until date of primary surgery. N0: Lymph node metastasis negative patients; N+: Lymph node metastasis positive patients; pT: Pathological tumor status; TSR: Tumor-stroma ratio.