Abstract
BackgroundThe clinical significance of tumor-stroma ratio (TSR) has been examined in many tumors. Here we systematically reviewed all studies that evaluated TSR in head and neck cancer.MethodsFour databases (Scopus, Medline, PubMed and Web of Science) were searched using the term tumo(u)r-stroma ratio. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) were followed.ResultsTSR was studied in nine studies of different subsites (including cohorts of nasopharyngeal, oral, laryngeal and pharyngeal carcinomas). In all studies, TSR was evaluated using hematoxylin and eosin staining. Classifying tumors based on TSR seems to allow for identification of high-risk cases. In oral cancer, specifically, our meta-analysis showed that TSR is significantly associated with both cancer-related mortality (HR 2.10, 95%CI 1.56–2.84) and disease-free survival (HR 1.84, 95%CI 1.38–2.46).ConclusionsThe assessment of TSR has a promising prognostic value and can be implemented with minimum efforts in routine head and neck pathology.
Highlights
The clinical significance of tumor-stroma ratio (TSR) has been examined in many tumors
After deleting duplicates and irrelevant papers, we found nine studies (Table 1) eligible to be included in this systematic review as they had analyzed tumor-stroma ratio (TSR) in head and neck cancer
We found that tumors with a high amount of stroma were associated with worse disease-specific survival with a hazard ratio (HR) of 2.10 and 95% confidence interval (CI) of 1.56 to 2.84 (Fig. 3a)
Summary
The clinical significance of tumor-stroma ratio (TSR) has been examined in many tumors. We systematically reviewed all studies that evaluated TSR in head and neck cancer. Squamous cell carcinoma of the head and neck is the most common tumor in this anatomic region. Analysis of prognostic markers expressed in tumor stroma has received more attention during the last decade. In recent studies the stroma of head and neck cancer has been analyzed mainly for specific molecules such as alpha-smooth muscle actin [2,3,4,5], which requires additional staining that is not routinely requested in daily clinical practice. For an ideal and practical prognostic marker, it is a great advantage that it can be assessed on routinely stained hematoxylin and eosin (HE) slides
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