A1 Refereed original research article in a scientific journal
Tumor-stroma ratio is a promising prognostic classifier in oropharyngeal cancer
Authors: Almangush Alhadi, Jouhi Lauri, Haglund Caj, Hagström Jaana, Mäkitie Antti A, Leivo Ilmo
Publisher: Elsevier
Publication year: 2023
Journal: Human Pathology
Journal name in source: Human pathology
Journal acronym: Hum Pathol
Volume: 136
First page : 16
Last page: 24
ISSN: 0046-8177
eISSN: 1532-8392
DOI: https://doi.org/10.1016/j.humpath.2023.03.010
Web address : https://doi.org/10.1016/j.humpath.2023.03.010
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/179586464
Tumor-stroma ratio (TSR) has been analyzed in many tumor types. To date, the clinical significance of TSR has not been investigated in oropharyngeal squamous cell carcinoma (OPSCC). We used a recently introduced recommendation for the assessment of TSR in a large cohort of 182 patients with OPSCC treated at the Helsinki University Hospital. The percentage of tumor-associated stroma was estimated in hematoxylin and eosin (HE)-stained sections and categorized into 2 groups: "stroma-high" (>50%) and "stroma-low" (≤50%). In multivariable analysis, TSR had a significant association with patient survival as stroma-high tumors showed worse disease-free survival (hazard ratio [HR] = 3.22, 95% confidence interval [CI] = 1.43-7.26, P = .005), disease-specific survival (HR = 2.48, 95% CI = 1.29-4.74, P = .006), and overall survival (HR = 2.23, 95% CI = 1.29-3.85, P = .004). The prognostic value of TSR was superior to the Tumor-Node-Metastasis classification. In addition, the significant prognostic value of TSR was demonstrated when analyzing human papillomavirus (HPV)-positive and HPV-negative cases separately (P < .05). In conclusion, TSR is a powerful prognostic indicator in OPSCC. It can be assessed quickly without additional costs using standard HE slides. Owing to its simplicity and reproducibility, TSR can be implemented in routine pathology diagnostics and reporting. Patients with stroma-rich tumors have an increased risk of recurrence and cancer-related mortality and may benefit from appropriate intensive treatment strategies with close follow-up.
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