Abstract
Tumor-related stroma plays an active role in tumor invasion and metastasis. The tumor–stroma ratio (TSR) in the pathologic specimen has drawn increasing attention from the field of predicting tumor prognosis. However, the prognostic value of TSR in solid tumors necessitates further elucidation. We conducted a meta-analysis on 14 studies with 4238 patients through a comprehensive electronic search on databases updated on May 2016 to explore the relationship between TSR and prognosis of solid tumors. The overall hazard ratio showed that rich stroma in tumor tissue was associated with poor overall survival (OS) (14 studies, 4238 patients) and disease-free survival (DFS) (9 studies, 2235 patients) of patients with solid tumors. The effect of low TSR on poor OS was observed among various cancer types, but not in the early stage of cervical caner. A significant relationship between low TSR and poor OS was also observed in the subgroup analyses based on study region, blinding status, and Newcastle–Ottawa Scale (NOS) score. Subgroup analyses indicated that cancer type, clinical stage, study region, blinding status, and NOS score did not affect the prognostic value of TSR for DFS. Moreover, low TSR was significantly correlated with the serious clinical stage, advanced depth of invasion, and positive lymph node metastasis. These findings indicate that a high proportion of stroma in cancer tissue is associated with poor clinical outcomes in cancer patients, and TSR may serve as an independent prognostic factor for solid tumors.
Highlights
Tumor aggression is considered to be a multifactor process and is significantly influenced by the microenvironment
tumor–stroma ratio (TSR), which is evaluated through the hematoxylin and eosin (H&E) stained sections, was first proposed by Mesker [22] in colorectal cancer (CRC) patients, and has been extended to other cancer types
The patients were divided into “stroma-rich” or “stroma-poor” groups according to the best cutoff of TSR = 50% because the prognostic difference between the two groups was most significant under this threshold
Summary
Tumor aggression is considered to be a multifactor process and is significantly influenced by the microenvironment. Cancer-related stromal components could actively facilitate the growth, differentiation, and movement of cancer cells in a tumor tissue [1]. The stroma surrounding the cancer cells is not passive, as it plays an active role in supporting and nourishing tumor parenchyma [3]. The crosstalk between the neoplastic cells and the associated stroma contributes to the functional and structural support of the tumor microenvironment, leading to tumor progression and metastasis [4, 5]. Aggressive tumor cells exploit the tumor microenvironment by residing in the stroma, transforming the surrounding tissue, and modifying the metabolism of the resident cells [6]. Tumor-related stroma could provide novel and alternative strategies for biological intervention in the treatment of malignant tumors
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