Armin  Gerger,Austrian Breast and  Colorectal Cancer Study Group (ABCSG),Evelyne  Bareck,Gabi W.  van Pelt,Hans  Rabl,Hans  Gelderblom,Klaus  Geissler,Martin  Filipits,Michael  Gnant,Peter  Götzinger,Renate  Schaberl-Moser,Richard  Greil,Rob A.  Tollenaar,Stefan W.  de Vroome,Stéphanie M. Zunder,Thomas  Bachleitner-Hofmann,Wilma E.  Mesker,Wolfgang  Hilbe,
Prognostic and Predictive Value of the Tumor-Stroma Ratio in STAGE II Colon Cancer
Clinical Oncology and Research
2020
2613-4942
http://dx.doi.org/10.31487/j.COR.2020.04.12
https://www.sciencerepository.org/prognostic-and-predictive-value-of-the-tumor-stroma-ratio-in_COR-2020-4-112 
Abstract: Background: Tumor-stroma ratio (TSR) is an independent prognosticator in colon cancer.
Objective: We set out to investigate the predictive power, as well as to validate the prognostic power of
TSR in stage II colon cancer patients. Better identification of patients who could benefit from adjuvant
chemotherapy remains an important issue in stage II disease.
Methods: TSR was microscopically determined on haematoxylin and eosin-stained primary tumor tissue
slides of 212 patients who received either adjuvant chemotherapy or surveillance after curative resection in
a prospective randomized clinical trial (ABCSG-91).
Results: Stroma-high tumors were associated with significantly more cancer-related death ((CaDeath) HR
2.30, 95% CI 1.05−5.03; p=0.037) and significantly shorter distant recurrence-free survival ((DRFS) HR
2.32, 95% CI 1.10−4.87; p=0.027) compared to stroma-low tumors. Backward multivariate Cox-regression
analysis demonstrated TSR as an independent prognosticator for DRFS (p=0.027) and CaDeath (p=0.031).
TSR did not validate as a predictive biomarker; CaDeath (HR 0.87, 95% CI 0.18−4.17; p=0.87), DRFS (HR
0.76, 95% CI 0.17−3.36; p=0.71) and OS (HR 0.96, 95% CI 0.29−3.21; p=0.95) for the type of
chemotherapy given in ABCSG-91.
Conclusions: TSR, an easily applicable and inexpensive observer-based method, is an independent
predictor of poor prognosis in stage II colon cancer. Predictive value for adjuvant 5-FU/leucovorin could
not be demonstrated.Keywords: Colon cancer, tumor stroma, biomarker, treatment, prognosis, prediction