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

He, Ruyuan; Li, Donghang; Liu, Bohao; Rao, Jie; Meng, Heng; Lin, Weichen; Fan, Tao; Hao, Bo; Zhang, Lin; Lu, Zilong; Feng, Haojie; Zhang, Ziyao; Yuan, Jingping; Geng, Qing

doi:10.7150/jca.50439

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

Research Paper

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

Ruyuan He^1#, Donghang Li^1#, Bohao Liu¹, Jie Rao², Heng Meng¹, Weichen Lin¹, Tao Fan¹, Bo Hao¹, Lin Zhang¹, Zilong Lu¹, Haojie Feng¹, Ziyao Zhang¹, Jingping Yuan², Qing Geng^1✉

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.

Citation:

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. https://www.jcancer.org/v12p1105.htm

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Abstract

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

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APA

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. (2021). The prognostic value of tumor-stromal ratio combined with TNM staging system in esophagus squamous cell carcinoma. Journal of Cancer, 12(4), 1105-1114. https://doi.org/10.7150/jca.50439.

ACS

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.

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CSE

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. 2021. The prognostic value of tumor-stromal ratio combined with TNM staging system in esophagus squamous cell carcinoma. J Cancer. 12(4):1105-1114.

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