학술논문
Tumour‐stroma ratio has poor prognostic value in nonpedunculated T1 colorectal cancer: A multicentre case‐cohort study
Document Type
Case study
Report
Report
Author
Dang, Hao; Van Pelt, Gabi W.; Haasnoot, Krijn J.C.; Backes, Yara; Elias, Sjoerd G.; Seerden, Tom C.J.; Schwartz, Matthijs P.; Spanier, Bernhard W.M.; Cappel, Wouter H. De Vos Tot Nederveen; Van Bergeijk, Jeroen D.; Kessels, Koen; Geesing, Joost M.J.; Groen, John N.; Ter Borg, Frank; Wolfhagen, Frank H.J.; Seldenrijk, Cornelis A.; Raicu, Mihaela G.; Milne, Anya N.; Van Lent, Anja U.G.; Brosens, Lodewijk A.A.; Offerhaus, G. Johan A.; Siersema, Peter D.; Tollenaar, Rob A.E.M.; Hardwick, James C.H.; Hawinkels, Lukas J.A.C.; Moons, Leon M.G.; Lacle, Miangela M.; Mesker, Wilma E.; Boonstra, Jurjen J.
Source
United European Gastroenterology Journal. May 2021, Vol. 9 Issue 4, p478, 8 p.
Subject
Language
English
Abstract
INTRODUCTION With the introduction of population‐based screening programmes, a growing number of early invasive colorectal cancers (T1 CRC) are being diagnosed.[sup.1] These tumours can be cured by local resection, as [...]
: 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: Haematoxylin and eosin (H&E)‐stained tumour tissue slides from a retrospective multicentre case cohort of patients with nonpedunculated 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.
: 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: Haematoxylin and eosin (H&E)‐stained tumour tissue slides from a retrospective multicentre case cohort of patients with nonpedunculated 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.