J Cancer 2021; 12(4):1105-1114. doi:10.7150/jca.50439 This issue

Research Paper

The prognostic value of tumor-stromal ratio combined with TNM staging system in esophagus squamous cell carcinoma

Ruyuan He1#, Donghang Li1#, Bohao Liu1, Jie Rao2, Heng Meng1, Weichen Lin1, Tao Fan1, Bo Hao1, Lin Zhang1, Zilong Lu1, Haojie Feng1, Ziyao Zhang1, Jingping Yuan2, Qing Geng1✉

1. Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
2. Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, China
# These authors contributed equally to the work.

This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions.
He R, Li D, Liu B, Rao J, Meng H, Lin W, Fan T, Hao B, Zhang L, Lu Z, Feng H, Zhang Z, Yuan J, Geng Q. The prognostic value of tumor-stromal ratio combined with TNM staging system in esophagus squamous cell carcinoma. J Cancer 2021; 12(4):1105-1114. doi:10.7150/jca.50439. Available from https://www.jcancer.org/v12p1105.htm

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Background: Tumor stroma is a crucial component of the tumor environment that interacted with tumor cells and modulated tumor cell proliferation, immune evasion, and metastasis. Tumor-stromal ratio (TSR) has been confirmed as an influential independent prognostic factor for diverse types of cancer, but it was seldom discussed in esophagus squamous cell carcinoma (ESCC).

Methods: In present study, pathological sections from the most invasive part of the ESCC of 270 patients were analyzed for their TSR by visual inspection and software. The TSR was combined with the TNM staging system to further explain its predictive value of prognosis. The 57 cases ESCC from TCGA database also were included as an independently validated cohort.

Results: Our results indicated that TSR was a robust prognostic factor for ESCC patients. TSR by visual inspection was dependable to reflect the stroma percent of the tumor compared to software calculation. Compared with stroma-low groups, the risk of death increased by 153.1% for patients in the stroma-high group [HR=2.531 (95%CI 1.657-3.867), P<0.001]. The results of ROC analysis in two cohorts indicated that TSNM staging system had better resolving ability with the largest area under the curve [0.698 95%CI (0.635-0.760), 0.691 95%CI (0.555-0.807)], compare to TNM. The novel TSNM staging system revealed strong predictive performance (P<0.001).

Conclusion: TSR was a reliable dependent indicator for ESCC prognosis. The TSNM staging system has a better discriminative ability than the conventional TNM staging system, especially for III stage patients.

Keywords: ESCC, tumor-stromal ratio, TNM staging system, prognosis, pathology