Medicine, Health & Food

Medicine, Health & Food

Correlation of Tumor-Stroma Ratio (TSR) With Primary Tumor Size and Lymph Node Involvement in Nasopharyngeal Carcinoma

Pages: 4  ,  Volume: 42  ,  Issue: 1 , December   2019
Received: 17 Dec 2019  ,  Published: 19 December 2019
Views: 174  ,  Download: 75


# Author Name
1 Fiora Octrin Purba, Soekimin, T Ibnu Alferraly


Background: Nasopharyngeal carcinoma (NPC) is the fifth most common malignancy in Indonesia. Diagnosis of NPC is frequently established in late stage showing regional lymph node metastasis. Tumor-stroma ratio (TSR) has recently been identified as one of independent prognostic factor for several solid tumor, which low TSR (predomination of stromal component) correlates with unfavorable prognosis and increased risk of relapse.

Objective: This study aimed to investigate the correlation of TSR with tumor size and lymph node involvement in NPC.

Material and Method: A total of 68 hematoxylin-eosin stained histological slides of patients with NPC who underwent biopsy were reviewed. The percentage of tumor stroma was visually estimated with cut-off value of 50% stroma percentage. Patients with <50% stroma were categorized as high TSR group and those with ≥ 50% stroma were classified as low TSR group. Correlations of TSR with tumor size and lymph node involvement were determined using Spearman correlation test.

Result: Based on data, of 68 patients; 36 (52,9%) had low TSR and 32 (47,1%) had high TSR.  Tumor T2 had highest percentage in both low and high TSR (44,4% and 43,75%). The low TSR patients had higher number of positive N stage than high TSR.  TSR was not significantly correlated with tumor size (p=0,410) and lymph node involvement (p=0,507). These results demonstrated that TSR itself could not clearly predict progression of T&N stage of NPC.

Conclusion: Stroma percentage was not correlated with tumor size and lymph node involvement in NPC.


  • nasopharyngeal carcinoma;tumor-stroma ratio;tumor microenvironment
  • References

    Adham M, Kurniawan AN, Muhtadi AI, Roezin A, Hermani B, Gondhowiardjo S, et al. Nasopharyngeal carcinoma in Indonesia: epidemiology, incidence,signs, and symptoms at presentation. Chin J Cancer. 2012;31(4):185–96.

    Chrestella J, Farhat F, Daulay ER, Asnir RA, Yudhistira A, Nasution IA. Cyclooxygenase-2 expression and its correlation with primary tumor size and lymph node involvement in nasopharyngeal carcinoma. Maced J Med Sci. 2018;6(11):2001–5.

    Chua MLK, Wee JTS, Hui EP, Chan ATC. Nasopharyngeal carcinoma. Lancet [Internet]. 2015;6736(15):1–13. Available from:

    Earnesty G. Hubungan nilai mean platelet volume terhadap stadium klinis dan tipe histopatologi pada penderita karsinoma nasofaring di RSUP Haji Adam Malik Medan pada Tahun 2014 – 2016 [Internet]. Universitas Sumatera Utara; 2018. Available from:

    Fasyah I. Response Rate Post Kemoradioterapi pada penderita KNF di RSUP.H.Adam Malik Medan Tahun 2014 - 2016 [Internet]. Universitas Sumatera Utara; 2018. Available from:

    Jia W, Qin H. Seminars in Cancer Biology Non-viral environmental risk factors for nasopharyngeal carcinoma?: A systematic review. Semin Cancer Biol  2012;22(2):117–26.

    Li J, Zou X, Wu Y, Guo J, Yun J, Xu M, et al. A Comparison between the Sixth and Seventh Editions of the UICC / AJCC Staging System for Nasopharyngeal Carcinoma in a Chinese Cohort. PLoS One. 2014;119:1–20.

    Petersson B, Bell D, El-Mofty SK, Gillison M, Lewis JS, Nadal A, et al. Nasopharyngeal carcinoma. In: El-Naggar AK, Chan JK, Grandis J, Takata T, Slootweg PJ, editors. WHO Classification of Head and Neck Tumours. 4th Ed. Lyon: IARC; 2017. pp. 64–70.

    Tambunan NS. Hubungan ekspresi imunohistokimia Vascular Endothelial Growth Factor (VEGF) dan Tumor-infiltrating lymphocytes (TILs) dengan tipe histopatologi dan stadium klinis karsinoma nasofaring [Internet]. Universitas Sumatera Utara; 2016. Available from: II.pdf?...4...%0A.

    WHO. Indonesia [Internet]. IARC. 2019. Available from: sheets.pdf.

    Zhang X, Zhang Z, Liu F, Cheng Y. The Tumor-stroma ratio is an independent predictor for survival in nasopharyngeal cancer. Oncol Res Treat. 2014;37:480–4.