Dandan Yan1, Xianli Ju1, Bin Luo1, Feng Guan1, Huihua He1, Honglin Yan1, Jingping Yuan2. 1. Department of Pathology, Renmin Hospital of Wuhan University, 238 Jiefang-Road, Wuchang District, Wuhan, 430060, People's Republic of China. 2. Department of Pathology, Renmin Hospital of Wuhan University, 238 Jiefang-Road, Wuchang District, Wuhan, 430060, People's Republic of China. yuanjingping@whu.edu.cn.
Abstract
BACKGROUND: The tumour-stroma ratio (TSR) is identified as a promising prognostic parameter for breast cancer, but the cutoff TSR value is mostly assessed by visual assessment, which lacks objective measurement. The aims of this study were to optimize the cutoff TSR value, and evaluate its prognosis value in patients with breast cancer both as continuous and categorical variables. METHODS: Major clinicopathological and follow-up data were collected for a series of patients with breast cancer. Tissue microarray images stained with cytokeratin immunohistochemistry were evaluated by automated quantitative image analysis algorithms to assess TSR. The potential cutoff point for TSR was optimized using maximally selected rank statistics. The association between TSR and 5-year disease-free survival (5-DFS) was assessed by Cox regression analysis. Kaplan-Meier analysis and log-rank test were used to assess the significance in survival analysis. RESULTS: The optimal cut-off TSR value was 33.5%. Using this cut-off point, categorical variable analysis found that low TSR (i.e., high stroma, TSR ≤ 33.5%) predicts poor outcomes for 5-DFS (hazard ratio [HR] = 2.82, 95% confidence interval [CI] = 1.81-4.40, P = 0.000). When TSR was considered as a continuous parameter, results showed that increased stroma content was associated with worse 5-DFS (HR = 1.71, 95% CI = 1.34-2.18, P = 0.000). Similar results were also obtained in three molecular subtypes in continuous and categorical variable analyses. Moreover, in the Kaplan-Meier analysis, log-rank test showed that low TSR displayed a worse 5-DFS than high TSR (P = 0.000). Similar results were also obtained in patients with triple-negative breast cancer, human epidermal growth factor receptor 2 (HER2)-positive breast cancer, and luminal-HER2-negative breast cancer. CONCLUSION: TSR is an independent predictor for 5-DFS in breast cancer with worse survival outcomes in low TSR. The prognostic value of TSR was also observed in other three molecular subtypes.
BACKGROUND: The tumour-stroma ratio (TSR) is identified as a promising prognostic parameter for breast cancer, but the cutoff TSR value is mostly assessed by visual assessment, which lacks objective measurement. The aims of this study were to optimize the cutoff TSR value, and evaluate its prognosis value in patients with breast cancer both as continuous and categorical variables. METHODS: Major clinicopathological and follow-up data were collected for a series of patients with breast cancer. Tissue microarray images stained with cytokeratin immunohistochemistry were evaluated by automated quantitative image analysis algorithms to assess TSR. The potential cutoff point for TSR was optimized using maximally selected rank statistics. The association between TSR and 5-year disease-free survival (5-DFS) was assessed by Cox regression analysis. Kaplan-Meier analysis and log-rank test were used to assess the significance in survival analysis. RESULTS: The optimal cut-off TSR value was 33.5%. Using this cut-off point, categorical variable analysis found that low TSR (i.e., high stroma, TSR ≤ 33.5%) predicts poor outcomes for 5-DFS (hazard ratio [HR] = 2.82, 95% confidence interval [CI] = 1.81-4.40, P = 0.000). When TSR was considered as a continuous parameter, results showed that increased stroma content was associated with worse 5-DFS (HR = 1.71, 95% CI = 1.34-2.18, P = 0.000). Similar results were also obtained in three molecular subtypes in continuous and categorical variable analyses. Moreover, in the Kaplan-Meier analysis, log-rank test showed that low TSR displayed a worse 5-DFS than high TSR (P = 0.000). Similar results were also obtained in patients with triple-negative breast cancer, human epidermal growth factor receptor 2 (HER2)-positive breast cancer, and luminal-HER2-negative breast cancer. CONCLUSION: TSR is an independent predictor for 5-DFS in breast cancer with worse survival outcomes in low TSR. The prognostic value of TSR was also observed in other three molecular subtypes.
Authors: Paolo Aurello; Giammauro Berardi; Diego Giulitti; Antonio Palumbo; Simone Maria Tierno; Giuseppe Nigri; Francesco D'Angelo; Emanuela Pilozzi; Giovanni Ramacciato Journal: Surgeon Date: 2017-06-17 Impact factor: 2.392
Authors: Carina Strell; Janna Paulsson; Shao-Bo Jin; Nicholas P Tobin; Artur Mezheyeuski; Pernilla Roswall; Ceren Mutgan; Nicholas Mitsios; Hemming Johansson; Sarah Marie Wickberg; Jessica Svedlund; Mats Nilsson; Per Hall; Jan Mulder; Derek C Radisky; Kristian Pietras; Jonas Bergh; Urban Lendahl; Fredrik Wärnberg; Arne Östman Journal: J Natl Cancer Inst Date: 2019-09-01 Impact factor: 13.506
Authors: Wilma E Mesker; Jan M C Junggeburt; Karoly Szuhai; Pieter de Heer; Hans Morreau; Hans J Tanke; Rob A E M Tollenaar Journal: Cell Oncol Date: 2007 Impact factor: 6.730
Authors: Kiki M H Vangangelt; Andrew R Green; Isabelle M F Heemskerk; Danielle Cohen; Gabi W van Pelt; Marcelo Sobral-Leite; Marjanka K Schmidt; Hein Putter; Emad A Rakha; Rob A E M Tollenaar; Wilma E Mesker Journal: Int J Cancer Date: 2020-01-22 Impact factor: 7.396