Tumor-Stroma Ratio within the Primary Tumor Is a Prognostic Factor in Early Breast Cancer Patients, Especially in Triple-Negative-Carcinoma Patients.

Abstract

Background: Breast cancer patients comprise a prognostic heterogeneous group. Stroma-tissue surrounding cancer cells plays an important role in tumor behavior. The prognostic value of the tumor-stroma ratio was evaluated.Material and Methods: A cohort of 574 patients with early breast cancer, primarily treated by surgery between 1985 and 1994 was analyzed. The percentage of intra-tumoral stroma was visually estimated on haematoxylin-eosin-stained histological sections from primary tumor tissue by two observers. Patients with more than 50% intra-tumor stroma were quantified as stroma-rich and patients with less than 50% intra-tumor stroma as stroma-poor.Results: Of all tumors, 68% were classified as stroma-rich and 32% as stroma-poor. Cohen's kappa coefficient revealed an almost perfect agreement in classification (kappa=0.85; 94% concordance in classification) between the two observers. For the total group of patients, stroma-rich tumors had a shorter relapse free period (RFP) (Hazard ratio (HR) 1.62; 95%CI 1.23-2.13; p=0.001) and overall survival (OS) (HR1.29; 95%CI 1.03-1.60; p=0.025) compared to stroma-poor tumors. Tumor-stroma ratio was an independent prognostic parameter for all patients (p<0.001) and in stratified analysis for patients that received systemic treatment. Importantly, within the triple-negative-cancer (TNC) subpopulation, patients with stroma-rich tumors had a 3.19 times higher risk of relapse (p=0.003) compared to patients with stroma-poor tumors, independently of grade and lymph node status. Five year RFP-rates for patients with stroma-rich compared to stroma-poor tumors were 56% and 81% respectively.Discussion: Tumor-stroma ratio was an independent prognostic factor for RFP in breast cancer patients, especially in TNC. The tumor-stroma ratio is easy to apply, of low cost and reproducible. It is a candidate parameter that can easily be implemented in routine daily diagnostics to optimize risk-stratification for breast cancer patients and should therefore be considered to be implemented in standard pathology reports. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3049.

Role of cancer-associated fibroblasts in breast cancer development and prognosis

“…Recently Yamashima and colleagues showed that the expression of the other important hallmark of myofibroblasts, a-SMA, correlates with invasive growth and poor clinical prognosis (Yamashita et al, 2010). Likewise, patients with stroma rich-tumors had a shorter relapse-free period and overall survival compared to stroma-poor tumors (de Kruijf et al, 2011). These fi ndings corroborate the previThese findings corroborate the previously shown association between the presence of large number of CAFs and high grade as well as poor prognosis (Cardone et al, 1997).…”

KOLAM : human computer interfaces fro visual analytics in big data imagery

“…In [67] Kruijf et al showed that tumor-stroma ratio is a prognostic factor for relapse-free period. Dekker et.…”