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. 2021 Nov 16:11:738080.
doi: 10.3389/fonc.2021.738080. eCollection 2021.

Impact of Tumor-Stroma Ratio on the Prognosis of Colorectal Cancer: A Systematic Review

Jinlai Gao  1 , Zhangguo Shen  2 , Zaixing Deng  1 , Lina Mei  3
Affiliations

Impact of Tumor-Stroma Ratio on the Prognosis of Colorectal Cancer: A Systematic Review

Jinlai Gao et al. Front Oncol. .

Abstract

Background: It is critical to develop a reliable and cost-effective prognostic tool for colorectal cancer (CRC) stratification and treatment optimization. Tumor-stroma ratio (TSR) may be a promising indicator of poor prognosis in CRC patients. As a result, we conducted a systematic review on the predictive value of TSR in CRC.

Methods: This study was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guideline. An electronic search was completed using commonly used databases PubMed, CENTRAL, Cochrane Central Register of Controlled Trials, and Google scholar till the last search up to May 30, 2021. STATA version 13 was used to analyze the data.

Results: A total of 13 studies [(12 for disease-free survival (DFS) and nine studies for overall survival (OS)] involving 4,857 patients met the inclusion criteria for the systematic review in the present study. In individuals with stage II CRC, stage III CRC, or mixed stage CRC, we observed a significantly higher pooled hazard ratio (HR) in those with a low TSR/greater stromal content (HR, 1.54; 95% CI: 1.20 to 1.88), (HR, 1.90; 95% CI: 1.35 to 2.45), and (HR, 1.70; 95% CI: 1.45 to 1.95), respectively, for predicting DFS. We found that a low TSR ratio had a statistically significant predictive relevance for stage II (HR, 1.43; 95% CI: 1.09 to 1.77) and mixed stages of CRC (HR, 1.65; 95% CI: 1.31 to 2.0) for outcome OS.

Conclusion: In patients with CRC, low TSR was found to be a prognostic factor for a worse prognosis (DFS and OS).

Keywords: colorectal cancer; meta-analysis; prognosis; stroma content; tumor–stroma ratio.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study flow diagram representing selection process of studies.
Figure 2
Figure 2
Methodological quality assessment of included studies in the present study. (A) Individual. (B) Overall.
Figure 3
Figure 3
Pooled hazard ratio for different stages of colorectal cancer (CRC) for predicting disease-free survival.
Figure 4
Figure 4
Pooled hazard ratio for different stages of colorectal cancer (CRC) for predicting overall survival.
Figure 5
Figure 5
Sensitivity analysis. (A) Disease-free survival. (B) Overall survival.
Figure 6
Figure 6
Funnel plot showing publication bias. (A) Disease-free survival. (B) Overall survival.
See this image and copyright information in PMC

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