Association between tumor-stroma ratio and prognosis in solid tumor patients: a systematic review and meta-analysis

Abstract

Tumor-related stroma plays an active role in tumor invasion and metastasis. The tumor-stroma ratio (TSR) in the pathologic specimen has drawn increasing attention from the field of predicting tumor prognosis. However, the prognostic value of TSR in solid tumors necessitates further elucidation. We conducted a meta-analysis on 14 studies with 4238 patients through a comprehensive electronic search on databases updated on May 2016 to explore the relationship between TSR and prognosis of solid tumors. The overall hazard ratio showed that rich stroma in tumor tissue was associated with poor overall survival (OS) (14 studies, 4238 patients) and diseasefree survival (DFS) (9 studies, 2235 patients) of patients with solid tumors. The effect of low TSR on poor OS was observed among various cancer types, but not in the early stage of cervical caner. A significant relationship between low TSR and poor OS was also observed in the subgroup analyses based on study region, blinding status, and Newcastle-Ottawa Scale (NOS) score. Subgroup analyses indicated that cancer type, clinical stage, study region, blinding status, and NOS score did not affect the prognostic value of TSR for DFS. Moreover, low TSR was significantly correlated with the serious clinical stage, advanced depth of invasion, and positive lymph node metastasis. These findings indicate that a high proportion of stroma in cancer tissue is associated with poor clinical outcomes in cancer patients, and TSR may serve as an independent prognostic factor for solid tumors.

Prognostic Nomogram Based on Histological Characteristics of Fibrotic Tumor Stroma in Patients Who Underwent Curative Resection for Intrahepatic Cholangiocarcinoma

“…Recently, a meta‐analysis that reviewed 14 studies on eight different types of malignancies found that TSR was correlated with unfavorable OS ( p < .001, pooled HR = 1.89; 95% CI 1.56–2.29) and disease‐free survival ( p < .001, pooled HR = 2.10; 95% CI 1.67–2.63). Moreover, stroma‐rich cancer was prone to have advanced clinical stage ( p = .012; pooled odds ratio [OR] = 1.68; 95% CI 1.20–2.51) and LN metastasis ( p = .008; pooled OR = 1.72; 95% CI 1.16–2.55) . However, in our study on ICC, TSR was not an independent prognostic factor for survival ( p = .189, HR = 1.399, 95% CI 0.848–2.309 for OS; p = .488, HR = 1.160, 95% CI 0.763–1.763).…”

Prognostic significance of tumor budding, tumor‐stroma ratio, cell nests size, and stroma type in laryngeal and pharyngeal squamous cell carcinomas

“…Our results are in concordance with previous studies. A meta‐analysis on 14 studies showed that stroma‐rich tumors show poor overall survival and disease‐free survival of patients with several types of solid tumors, like breast, colorectal, lung, and liver tumors . The patients of these studies were similarly divided into stroma‐rich and stroma‐poor groups according to the best cutoff of 50% because the prognostic difference between the two groups was most significant under this threshold .…”

“…Similarly, the stroma could be fibroblastic when composed of loose connective tissue or more fibrotic when a dense homogeneous collagenous stroma is found, while the size of tumor cell nests which are defined as clusters of tumor cells surrounded by stroma can also be important prognostic parameters. These factors have shown important prognostic significance in various forms of cancer, like colorectal, breast, and lung carcinomas, and from HNSCC, only in oral cancer …”

Association Between Pretreatment Serum Apolipoprotein A1 and Prognosis of Solid Tumors in Chinese Population: A Systematic Review and Meta-Analysis

“…The synthesized data suggested that decreased level of serum apoA1 was significantly correlated with some phenotypes of tumor progression, such as larger tumor size, poor histological grade, and advanced clinical stage. All these aggressive tumor behaviors have been documented to be independent factors related to tumor progression and compromise survival outcome [49, 50]. Herein, apoA1 played an important role in the inhibition of tumor progression through different pathways.…”