학술논문
Tumour-stroma ratio has poor prognostic value in non-pedunculated T1 colorectal cancer: A multi-centre case-cohort study.
Document Type
Academic Journal
Author
Dang H; Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands.; van Pelt GW; Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.; Haasnoot KJ; Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.; Backes Y; Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.; Elias SG; Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.; Seerden TC; Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, The Netherlands.; Schwartz MP; Department of Gastroenterology and Hepatology, Meander Medical Centre, Amersfoort, The Netherlands.; Spanier BW; Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands.; de Vos Tot Nederveen Cappel WH; Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, The Netherlands.; van Bergeijk JD; Department of Gastroenterology and Hepatology, Gelderse Vallei, Ede, The Netherlands.; Kessels K; Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, The Netherlands.; Geesing JM; Department of Gastroenterology and Hepatology, Diakonessenhuis, Utrecht, The Netherlands.; Groen JN; Department of Gastroenterology and Hepatology, Sint Jansdal, Harderwijk, The Netherlands.; Ter Borg F; Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, The Netherlands.; Wolfhagen FH; Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.; Seldenrijk CA; Pathology DNA, Sint Antonius Hospital, Nieuwegein, The Netherlands.; Raicu MG; Pathology DNA, Sint Antonius Hospital, Nieuwegein, The Netherlands.; Milne AN; Pathology DNA, Sint Antonius Hospital, Nieuwegein, The Netherlands.; van Lent AU; Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.; Brosens LA; Department of Pathology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.; Offerhaus GJA; Department of Pathology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.; Siersema PD; Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands.; Tollenaar RA; Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.; Hardwick JC; Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands.; Hawinkels LJ; Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands.; Moons LM; Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.; Lacle MM; Department of Pathology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.; Mesker WE; Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.; Boonstra JJ; Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands.
Source
Publisher: Wiley Country of Publication: England NLM ID: 101606807 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2050-6414 (Electronic) Linking ISSN: 20506406 NLM ISO Abbreviation: United European Gastroenterol J Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Current risk stratification models for early invasive (T1) colorectal cancer are not able to discriminate accurately between prognostic favourable and unfavourable tumours, resulting in over-treatment of a large (>80%) proportion of T1 colorectal cancer patients. The tumour-stroma ratio (TSR), which is a measure for the relative amount of desmoplastic tumour stroma, is reported to be a strong independent prognostic factor in advanced-stage colorectal cancer, with a high stromal content being associated with worse prognosis and survival. We aimed to investigate whether the TSR predicts clinical outcome in patients with non-pedunculated T1 colorectal cancer.
Methods: Hematoxylin and eosin (H&E)-stained tumour tissue slides from a retrospective multi-centre case cohort of patients with non-pedunculated surgically treated T1 colorectal cancer were assessed for TSR by two independent observers who were blinded for clinical outcomes. The primary end point was adverse outcome, which was defined as the presence of lymph node metastasis in the resection specimen or colorectal cancer recurrence during follow-up.
Results: All 261 patients in the case cohort had H&E slides available for TSR scoring. Of these, 183 were scored as stroma-low, and 78 were scored as stroma-high. There was moderate inter-observer agreement (κ = 0.42). In total, 41 patients had lymph node metastasis, 17 patients had recurrent cancer and five had both. Stroma-high tumours were not associated with an increased risk for an adverse outcome (adjusted hazard ratio = 0.66, 95% confidence interval 0.37-1.18; p = 0.163).
Conclusions: Our study emphasises that existing prognosticators may not be simply extrapolated to T1 colorectal cancers, even though their prognostic value has been widely validated in more advanced-stage tumours.
Methods: Hematoxylin and eosin (H&E)-stained tumour tissue slides from a retrospective multi-centre case cohort of patients with non-pedunculated surgically treated T1 colorectal cancer were assessed for TSR by two independent observers who were blinded for clinical outcomes. The primary end point was adverse outcome, which was defined as the presence of lymph node metastasis in the resection specimen or colorectal cancer recurrence during follow-up.
Results: All 261 patients in the case cohort had H&E slides available for TSR scoring. Of these, 183 were scored as stroma-low, and 78 were scored as stroma-high. There was moderate inter-observer agreement (κ = 0.42). In total, 41 patients had lymph node metastasis, 17 patients had recurrent cancer and five had both. Stroma-high tumours were not associated with an increased risk for an adverse outcome (adjusted hazard ratio = 0.66, 95% confidence interval 0.37-1.18; p = 0.163).
Conclusions: Our study emphasises that existing prognosticators may not be simply extrapolated to T1 colorectal cancers, even though their prognostic value has been widely validated in more advanced-stage tumours.