Medicine, Health & Food

Medicine, Health & Food

CORRELATION OF TUMOR-STROMA RATIO (TSR) WITH HISTOLOGICAL GRADING AND STAGING IN COLORECTAL ADENOCARCINOMA

Pages: 7  ,  Volume: 45  ,  Issue: 1 , January   2020
Received: 20 Jan 2020  ,  Published: 27 January 2020
Views: 29  ,  Download: 0

Authors

# Author Name
1 Sylvia Hilda
2 Soekimin
3 Betty

Abstract

Background: Colorectal carcinoma ranks the third-largest in the world, and second as the cause of death from cancer. Risk factors include precursor lesions such as adenomas and dysplasia and diets of high in calorie and animal fat accompanied by lack of physical activity. In addition to grading and histological staging, the prognosis is also influenced by the reaction between the tumor and the stroma (Tumor-Stroma Ratio / TSR) based on a comparison between the percentage of carcinomas and stroma, which is one of the most recent prognostic factors and is still not widely used.

Objective: To analyze the correlation between Tumor-Stroma Ratio (TSR) with histological grading and staging in colorectal adenocarcinoma.

Methods: 40 histopathological slide samples from the operating tissue of patients with a diagnosis of colorectal adenocarcinoma with hematoxylin-eosin staining assessed staging, grading and TSR scores. If the carcinoma component <30% (TSR-Low), carcinoma 40%-60% (TSR-Intermediate) and carcinoma >70% (TSR-High). 

Results and discussion: Most histological grading distributions are moderately differentiated, most staging is stage II, and the highest TSR score is Intermediate TSR. Based on the Spearman correlation test, it was found that there was a strong correlation between TSR scores with grading (p = 0.0001, r = +0.747) and a weak correlation between TSR and staging (p = 0.012, r = +0.395).

Conclusions: TSR is a prognostic factor in colorectal adenocarcinoma patients and should be reported in the diagnosis of an Anatomic Pathologist.

Keywords: Tumor-Stroma Ratio, colorectal prognosis.

Keywords

  • tumor-stroma ratio
  • colorectal prognosis
  • References

    1. Hamilton Hospital, Bosman TF, Boffeta P, M Ilyas, Morreau H, Nakamura SI, et al. 2010. Tumors of Colon and Rectum. In: Bosman TF, Carnerro F, HRruban HR, Theise DN, editors. World Health Organization Classification of Tumors Pathology and Genetics of Tumors of the Digestive System. 4th ed. France. IARC Press. pp103-44.
    2. Fleming M, Ravula S, Tatishchev SF, Wang HL. 2012. Colorectal Carcinoma: Pathological Aspects. Journal of Gastrointestinal Oncology Vol 3. pp153-73.
    3. Colorectal Cancer Facts & Figures 2017-2019. 2017. American Cancer Society. Atlanta. pp30.
    4. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. 2018. Global Cancer Statistics 2018. GLOBOCAN Estimates Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. pp396-419.
    5. International Agency for Research on Cancer. Indonesia, Source: Globocan 2018. Available from: http://gco.iarc.fr/today/data/factsheets/populations/360-indonesia-fact-sheets.pdf. 
    6. Nasution, Novia. 2018. Characteristics of Colorectal Cancer Patients in H. Adam Malik General Hospital Medan 2015-2017. [cited 2019 apr 24]. Available from: http://repositori.usu.ac.id/handle/123456789/11025.
    7. Edge SB and Chompson CC. 2016. American Joint Committee on Cancer, Cancer Staging Manual Eight Edition. Chapter 20. pp251-74.
    8. van Pelt GW, Kjaer-Frifeldt S, van Krieken JHJM, Al diphtheria, Morreau H, M. Tollenaar, et al. 2018. Scoring the tumor-stroma ratio in colon cancer: procedure and recommendation. [cited 2018 Oct 26] Available from: https://doi.org/10.1007/s00428-018-2408-z
    9. Scheer R, Baidoshvii A, Zoidze S,
    10. Le NH, Franken P, Fodde R. 2008. Tumor stromal interactions in colorectal cancer: converging on β-catenin activation and cancer stemness. British Journal on Cancer. pp1886-93.
    11. Zhang T, Xu J, Shen H, Dong W, Ni Y, Du J. 2015. Tumor-stroma ratio is an independent predictor for survival in NSCLC. Int J Clin Pathol. [cited 2018 Oct 8] Available from: www.ijcep.com.
    12. Panayiotou H, Orsi NM, Thygesen HH, Wright AI, Winder M, Hutson R, et al. 2015. The prognostic significance of tumor-stroma ratio in endometrial carcinoma. BMC Cancer 2015. [cited 2019 may 14]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26674153.
    13. Wang K, Ma W, Wang J, Yu L, Zhang X, Wang Z, et al. 2012. Tumor-stroma ratio is an independent predictor for survival in esophageal squamous cell carcinoma. J Thorac Oncol. pp1457-61.
    14. de Kruijf EM, van Nes JG, Van de V, Putter H, Smith VT, Liefers GJ, et al. 2011. Tumor-stroma ratio in the primary tumor is a prognostic factor in early breast cancer patients, especially in triple-negative carcinoma patients. Breast Cancer Res Treat. pp687-96.
    15. Huijbers A, Tollenaar RA, v. Pelt GW, Zeestraten EC, Dutton S, McConkey, et al. 2013. The proportion of tumor-stroma as a strong prognosticator for stage II and III colon cancer patients: validation in the VICTOR trial. Ann Oncol. pp179-85. Available from: https://academic.oup.com/annonc/article/24/1/179/1746464.  
    16. Z Lv, X Cai, X Weng, H Xiao, C Du, J Cheng, et al. 2015. Tumor-stroma ratio is a prognostic factor for survival in hepatocellular carcinoma patients after liver resection or transplantation. Surgery. pp142-50.
    17. Mesker WE, Liefers GJ, Junggeburt JM, van Pelt GW, Alberici P, Kuppen PJ, et al. 2009. Presence of a high amount of stroma and downregulation of SMAD4 predict for worse survival for stage I–II colon cancer patients. Cell Oncol 31(3).  pp169–78. Available from : https:// doi.org/10.3233/CLO-2009-0478.
    18. Panduan Penatalaksanaan Kanker Kolorektal. 2017. Komite Penanggulangan Kanker Nasional. Kementerian Kesehatan Republik Indonesia.
    19. Ueno H, Mochizuki H, Hashiguchi Y, Ishiguro M, Kajiwara Y, Sato T, et al. Histological grading of colorectal cancer: a simple and objective method. 2008. Ann Surg. pp 811-8.
    20. Clayton A, Evans RA, Pettit E, Hallett M, Williams JD, Steadman R. 1998. Cellular activation through the ligation of intercellular adhesion molecule-1. J Cell Sci 111. pp443–53.
    21. Mohan H. 2015. Textbook of Pathology. 7th ed. pp563-74.
    22. Li H, Fan X, Houghton JM. 2007.Tumor microenvironment: The role of the tumor stroma in cancer. Journal of cellular biochemistry. pp805-15.
    23. Sandler RS, Halabi S, Baron JA, Budinger S, Paskett E, Keresztes R, et al. 2003. A randomized trial of aspirin to prevent colorectal adenomas in patients with previous colorectal cancer. N Engl J Med 348 .pp883–90.
    24. Hansen TF, Kjaer-Frifeldt S, Lindebjerg J, Raafaelsen SR, Jensen LH, Jakobsen A, et al. 2017. Tumor-stroma ratio predicts recurrence in patients with colon cancer treated with neoadjuvant chemotherapy. Acta Oncologica Vol 57. Available from: https://doi.org/10.1080/0284186X.2017.1385841.