Abstract
The tumor–stroma ratio (TSR) was evaluated as a promising parameter for breast cancer prognostication in clinically relevant subgroups of patients. The TSR was assessed on hematoxylin and eosin‐stained tissue slides of 1,794 breast cancer patients from the Nottingham City Hospital. An independent second cohort of 737 patients from the Netherlands Cancer Institute to Antoni van Leeuwenhoek was used for evaluation. In the Nottingham Breast Cancer series, the TSR was an independent prognostic parameter for recurrence‐free survival (RFS; HR 1.35, 95% CI 1.10–1.66, p = 0.004). The interaction term was statistically significant for grade and triple‐negative status. Multivariate Cox regression analysis showed a more pronounced effect of the TSR for RFS in grade III tumors (HR 1.89, 95% CI 1.43–2.51, p < 0.001) and triple‐negative tumors (HR 1.86, 95% CI 1.10–3.14, p = 0.020). Comparable hazard ratios and confidence intervals were observed for grade and triple‐negative status in the ONCOPOOL study. The prognostic value of TSR was not modified by age, tumor size, histology, estrogen receptor status, progesterone receptor status, human epidermal growth factor receptor 2 status or lymph node status. In conclusion, patients with a stroma‐high tumor had a worse prognosis compared to patients with a stroma‐low tumor. The prognostic value of the TSR is most discriminative in grade III tumors and triple‐negative tumors. The TSR was not modified by other clinically relevant parameters making it a potential factor to be included for improved risk stratification.
Highlights
Breast cancer mortality rates are declining in most European countries due to early detection and improved treatment options [1]
The tumor-stroma ratio (TSR) reflects the amount of tumor stroma to the cancer cells, which is determined on routinely retrieved hematoxylin and eosin (H&E) stained tissue slides used for pathological assessment of surgically removed breast tissue
The Nottingham Breast Cancer series A total of 2385 H&E slides of 1809 patients were assessed for TSR
Summary
Breast cancer mortality rates are declining in most European countries due to early detection and improved treatment options [1]. Previous research demonstrated the prognostic value of the TSR in different types of invasive solid tumors, including breast cancer [7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32] Most of these studies validated a worse prognosis for patients with stroma-high tumors. This is an essential step towards prospective validation and clinical implementation, such as the addition of TSR to the frequently used online prediction tool PREDICT
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