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Review
. 2022 May 3;29(5):3232-3241.
doi: 10.3390/curroncol29050263.

Tumor Stroma Ratio and Its Significance in Locally Advanced Colorectal Cancer

Luz Sullivan  1 , Richard R Pacheco  1 , Michel Kmeid  1 , Anne Chen  1 , Hwajeong Lee  1
Affiliations
Review

Tumor Stroma Ratio and Its Significance in Locally Advanced Colorectal Cancer

Luz Sullivan et al. Curr Oncol. .

Abstract

Colorectal cancer is the third leading cause of cancer-related death, and its incidence is rising in the younger patient population. In the past decade, research has unveiled several processes (underlying tumorigenesis, many of which involve interactions between tumor cells and the surrounding tissue or tumor microenvironment (TME). Interactions between components of the TME are mediated at a sub-microscopic level. However, the endpoint of those interactions results in morphologic changes which can be readily assessed at microscopic examination of biopsy and resection specimens. Among these morphologic changes, alteration to the tumor stroma is a new, important determinant of colorectal cancer progression. Different methodologies to estimate the proportion of tumor stroma relative to tumor cells, or tumor stroma ratio (TSR), have been developed. Subsequent validation has supported the prognostic value, reproducibility and feasibility of TSR in various subgroups of colorectal cancer. In this manuscript, we review the literature surrounding TME in colorectal cancer, with a focus on tumor stroma ratio.

Keywords: colorectal cancer; immune cells; tumor budding; tumor microenvironment; tumor stroma ratio.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Illustration of the tumor stroma ratio (TSR) (a) Stroma-high tumor; (b) Stroma-low tumor. When assessing adequacy of a visual field, tumor cells should be present at four sides which are roughly 90 degrees from one another (arrows). Smooth muscle, lymphoid follicles and large vessels with thick muscular walls should be disregarded.
Figure 2
Figure 2
Flow chart summarizing steps to ensure accurate and reproducible evaluation of tumor stromal ratio (TSR) in adequate visual fields.
See this image and copyright information in PMC

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