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. 2021 Feb 10.
doi: 10.1177/2050640620975324. Online ahead of print.

Tumour-stroma ratio has poor prognostic value in nonpedunculated T1 colorectal cancer: A multicentre case-cohort study

Hao Dang  1 , Gabi W van Pelt  2 , Krijn J C Haasnoot  3 , Yara Backes  3 , Sjoerd G Elias  4 , Tom C J Seerden  5 , Matthijs P Schwartz  6 , Bernhard W M Spanier  7 , Wouter H de Vos Tot Nederveen Cappel  8 , Jeroen D van Bergeijk  9 , Koen Kessels  10 , Joost M J Geesing  11 , John N Groen  12 , Frank Ter Borg  13 , Frank H J Wolfhagen  14 , Cornelis A Seldenrijk  15 , Mihaela G Raicu  15 , Anya N Milne  15 , Anja U G van Lent  16 , Lodewijk A A Brosens  17 , G Johan A Offerhaus  17 , Peter D Siersema  18 , Rob A E M Tollenaar  2 , James C H Hardwick  1 , Lukas J A C Hawinkels  1 , Leon M G Moons  3 , Miangela M Lacle  17 , Wilma E Mesker  2 , Jurjen J Boonstra  1 ; Dutch T1 CRC Working Group
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Free article

Tumour-stroma ratio has poor prognostic value in nonpedunculated T1 colorectal cancer: A multicentre case-cohort study

Hao Dang et al. United European Gastroenterol J. .
Free article

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: 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.

Keywords: T1 colorectal cancer; desmoplasia; prognosis; tumour microenvironment; tumour-stroma ratio.

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References

REFERENCES

    1. Arnold M, Sierra MS, Laversanne M, et al. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017;66:683-91.
    1. Hashiguchi Y, Muro K, Saito Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol. 2020;25:1-42.
    1. Antonelli G, Vanella G, Orlando D, et al. Recurrence and cancer-specific mortality after endoscopic resection of low- and high-risk pT1 colorectal cancers: a meta-analysis. Gastrointest Endosc. 2019;90:559-69.
    1. Bosch SL, Teerenstra S, De Wilt JH, et al. Predicting lymph node metastasis in pT1 colorectal cancer: a systematic review of risk factors providing rationale for therapy decisions. Endoscopy. 2013;45:827-34.
    1. Miyachi H, Kudo SE, Ichimasa K, et al. Management of T1 colorectal cancers after endoscopic treatment based on the risk stratification of lymph node metastasis. J Gastroenterol Hepatol. 2016;31:1126-32.

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