Abstract
Tumor-stroma proportion of tumor has been presented as a prognostic factor in some types of adenocarcinomas, but there is no information about squamous cell carcinomas and laryngeal carcinomas. Five digital images of the tumor sections were obtained from 85 laryngeal carcinomas. Proportion of epithelial tumor component and stroma were measured by a software tool, allowing the pathologists to mark 205.6 μm2 blocks on areas as carcinomatous/stromal, by clicking at the image. Totally, 3.451 mm2 tumor areas have been marked to 16.785 small square blocks for each case. Median follow up was 48 months (range 3-194). The mean tumor-stroma proportion was 48.63+18.18. There was no difference for tumor-stroma proportion when tumor location, grade, stage and perinodal invasion were considered. Although the following results were statistically insignificant, the mean tumor-stroma proportion was the lowest (37.46±12.49) for subglottic carcinomas, and it was 52.41±37.47, 50.86+19.84 and 44.56±16.91 for supraglottic, transglottic and glottic cases. The tumor-stroma proportion was lowest in cases with perinodal invasion and the highest in cases without lymph node metastasis (44.72±20.23, 47.77±17.37, 50.05±17.34). Tumor-stroma proportion was higher in the basaloid subtype compared with the classical squamous cell carcinoma (53.76±14.70 and 48.63±18.38 respectively). The overall and disease-free survival analysis did not reveal significance for tumor-stroma proportion (p=0.08, p=0.38). Only pathological stage was an independent factor for overall survival (p=0.008). This is the first series investigating tumor-stroma proportion as a prognostic marker in laryngeal carcinomas proposing a new method, but the findings do not support tumor-stroma proportion as a prognostic marker.
Highlights
All malignant epithelial tumors composed of epithelial cells are admixed with supportive tissue, named as “stroma” and this special tissue includes vascular-lymphatic channels and inflammatory cells as well as some type of fibrous tissue, so called desmoplasia
There was no difference for tumor-stroma proportion when tumor location, grade, stage and perinodal invasion were considered
The tumor-stroma proportion was lowest in cases with perinodal invasion and the highest in cases without lymph node metastasis (44.72±20.23, 47.77±17.37, 50.05±17.34)
Summary
All malignant epithelial tumors composed of epithelial cells are admixed with supportive tissue, named as “stroma” and this special tissue includes vascular-lymphatic channels and inflammatory cells as well as some type of fibrous tissue, so called desmoplasia. Tumor-stroma ratio or tumor-stroma proportion (TSP) has been presented as a prognostic factor in some types of carcinomas, including prostate, colorectal, esophageal and breast adenocarcinomas [5,6,7,8,9,10,11]. Desmoplasia is presented as a poor prognostic factor in colon and lung adenocarcinoma [12,13,14] and in squamous cell carcinomas (SCC) of the skin and the desmoplastic variant of skin SCC is known as a very aggressive tumor [15,16,17,18]. Most of the laryngeal carcinomas originate from the supraglottic and glottic region. In this study the prognostic value of TSP is investigated in laryngeal SCC for the first time, in a series of patients treated with surgery and radiotherapy
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