Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2024 Oct 26;13(21):1772.
doi: 10.3390/cells13211772.

Prognostic Significance of Tumor-Stroma Ratio (TSR) in Head and Neck Squamous Cell Carcinoma: Systematic Review and Meta-Analysis

Affiliations
Meta-Analysis

Prognostic Significance of Tumor-Stroma Ratio (TSR) in Head and Neck Squamous Cell Carcinoma: Systematic Review and Meta-Analysis

Ilaria Girolami et al. Cells. .

Abstract

The management of head and neck squamous cell carcinoma (HNSCC) relies heavily on TNM staging and WHO histologic grading; however, in recent years, the analysis of prognostic markers expressed in the tumor stroma has gained attention. The tumor-stroma ratio (TSR) quantifies the proportion of tumor tissue relative to the surrounding stromal tissue; it is assessed with the percentage of stromal tissue within the tumor area, with a cutoff point of 50% being widely used to discriminate high-stroma cancer. In this systematic review and meta-analysis, we investigated the potential prognostic role of the TSR in HNSCC. After a literature screening, 24 studies dealing with the TSR and survival outcomes were included. The TSR showed a significant association with overall survival (OS) in both unadjusted and adjusted measures (RR 2.04, CI 1.57-2.65, p < 0.01; HR 2.36 CI 1.89-2.94, p < 0.00001), with an even stronger prognostic potential in oral cavity/oral tongue cancers (RR 2.44 CI 1.84-3.22, p < 0.00001). The TSR also showed prognostic value when dealing with cancer-specific survival and was associated with a reduction in disease-free survival (DFS). In particular, the TSR also retained its prognostic role in terms of DFS when specifically considering early-stage cancers in both unadjusted and adjusted analyses (RR 1.81 CI 1.57-2.10, p < 0.00001; HR 2.09 CI 1.58-2.76, p < 0.00001). Therefore, we conclude that the TSR is a reliable prognostic marker that is easy to assess in routine histological slides and can be effectively implemented in the routine evaluation of HNSCC.

Keywords: HNSCC; meta-analysis; oral cancer; prognostic markers; systematic review; tumor–stroma ratio.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart of article screening.
Figure 2
Figure 2
Forest plot of OS for unadjusted (a) [18,20,21,22,24,25,26,27,28,32,33,35,36] and adjusted (b) [18,20,22,24,26,28,32,38] measures.
Figure 3
Figure 3
Forest plot of comparison of OS in oral cavity cancer vs. other subsites. Refs. [18,20,21,22,24,25,26,27,28,32,33,35,36].
Figure 4
Figure 4
Forest plot of DSS for unadjusted (a) [19,22,31,32,33,39,40] and adjusted (b) [19,22,31,32,38,39,40] measures.
Figure 4
Figure 4
Forest plot of DSS for unadjusted (a) [19,22,31,32,33,39,40] and adjusted (b) [19,22,31,32,38,39,40] measures.
Figure 5
Figure 5
Forest plot of DFS for unadjusted (a) [18,19,20,21,22,23,24,26,28,3031,32,34,35,36,37,39,40,41] and adjusted (b) [18,19,20,22,23,24,26,28,29,31,32,37,38,39,40] measures.
Figure 5
Figure 5
Forest plot of DFS for unadjusted (a) [18,19,20,21,22,23,24,26,28,3031,32,34,35,36,37,39,40,41] and adjusted (b) [18,19,20,22,23,24,26,28,29,31,32,37,38,39,40] measures.
Figure 6
Figure 6
Forest plot of DFS for early-stage cancers for unadjusted (a) [18,26,31,39,40] and adjusted (b) [18,26,31,40] measures.

Similar articles

Cited by

References

    1. Sung H., Ferlay J., Siegel R.L., Laversanne M., Soerjomataram I., Jemal A., Bray F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA. Cancer J. Clin. 2021;71:209–249. doi: 10.3322/caac.21660. - DOI - PubMed
    1. Chow L.Q.M. Head and Neck Cancer. N. Engl. J. Med. 2020;382:60–72. doi: 10.1056/NEJMra1715715. - DOI - PubMed
    1. Almangush A., Alabi R.O., Troiano G., Coletta R.D., Salo T., Pirinen M., Mäkitie A.A., Leivo I. Clinical significance of tumor-stroma ratio in head and neck cancer: A systematic review and meta-analysis. BMC Cancer. 2021;21:480. doi: 10.1186/s12885-021-08222-8. - DOI - PMC - PubMed
    1. Dourado M.R., Guerra E.N.S., Salo T., Lambert D.W., Coletta R.D. Prognostic value of the immunohistochemical detection of cancer-associated fibroblasts in oral cancer: A systematic review and meta-analysis. J. Oral Pathol. Med. 2018;47:443–453. doi: 10.1111/jop.12623. - DOI - PubMed
    1. van Pelt G.W., Kjær-Frifeldt S., van Krieken J.H.J.M., Al Dieri R., Morreau H., Tollenaar R.A.E.M., Sørensen F.B., Mesker W.E. Scoring the tumor-stroma ratio in colon cancer: Procedure and recommendations. Virchows Arch. 2018;473:405–412. doi: 10.1007/s00428-018-2408-z. - DOI - PMC - PubMed

MeSH terms

LinkOut - more resources