The prognostic value of the tumour-stroma ratio in primary operable invasive cancer of the breast: a validation study

• Published in: Breast cancer research and treatment Vol. 166; no. 2; pp. 435 - 445
• Main Authors: Roeke, Toni, Sobral-Leite, Marcelo, Dekker, Tim J. A., Wesseling, Jelle, Smit, Vincent T. H. B. M., Tollenaar, Rob A. E. M., Schmidt, Marjanka K., Mesker, Wilma E.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.11.2017; Springer; Springer Nature B.V
• Subjects: Adult; Aged; Breast cancer; Breast Neoplasms - pathology; Cancer metastasis; Cancer research; Confidence intervals; Female; Health risk assessment; Humans; Invasiveness; Lymph nodes; Medicine; Medicine & Public Health; Metastases; Metastasis; Middle Aged; Neoplasm Grading; Neoplasm Metastasis; Oncology; Preclinical Study; Prognosis; Retrospective Studies; Stroma; Stromal Cells - pathology; Survival; Survival Analysis; Tumors; Stroma; Breast cancer; Prognosis; Tumour; Survival
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-017-4445-8

Purpose The primary aim of the current study is to validate the prognostic relevance of the relative amount of tumour-associated stroma, the tumour - stroma ratio , in a large cohort of primary operable breast cancer patients. Methods A retrospective cohort study was performed on women diagnosed and treated for primarily operable invasive breast cancer in the period from 1 January 1990 till 31 December 1999. Tumour-stroma ratio was estimated by microscopic evaluation of haematoxylin and eosin tumour slides. Two independent observers ( k  = 0.68) performed tumour-stroma ratio evaluation in a significant part of the cohort. The prognostic potential with respect to overall, recurrence-free and distant metastasis-free survival was evaluated. Results A total of n  = 737 women were evaluated. Median follow-up time was 11.5 years. High stromal content was an independent prognosticator for worse overall (hazard ratio 1.56, p  = 0.002, 95% confidence interval 1.18–2.05), distant metastasis-free (hazard ratio 1.52, p  = 0.008, 95% confidence interval 1.12–2.06) and recurrence-free survival (hazard ratio 1.35, p  = 0.046, 95% confidence interval 1.01–1.81). In subgroups of hormone receptor-positive and lymph node-negative cases, high stromal content was also an independent prognosticator for worse outcome. Conclusion Tumour-stroma ratio is an independent risk factor for worse overall, distant metastasis-free and recurrence-free survival in primarily operable breast cancer. However, detailed prospective studies with respect to tumour-stroma ratio are necessary to gain more insight in its prognostic potential in clinical practice.