title: The stromal part of adenocarcinomas of the oesophagus: does it conceal targets for therapy?
abstract: OBJECTIVE
  To evaluate the prognostic value of the tumour stroma ratio (TSR) in resected adenocarcinoma of the oesophagus.
  
  
  BACKGROUND
  In the literature, a refinement of oesophageal cancer staging has been proposed. Recently, TSR has been identified as a histological characteristic of the tumour itself that proved to be a strong predictor for survival in colorectal cancer.
  
  
  METHODS
  In our cancer registry database, we identified 93 consecutive patients who underwent resection for oesophageal adenocarcinoma between 1990 and 2004 in two hospitals in our region. Using a predefined histopathological protocol, TSR was determined on the original haematoxylin-eosin (H&E) tissue sections of oesophagectomy specimens by two independent investigators.
  
  
  RESULTS
  With a cut-off value of 50% tumour/stroma, patients were classified as TSR high (n=60) or TSR low (n=33). There were no significant differences in patient, tumour and treatment characteristics between the two groups, except for M status (M1a) and radicality of resection. The (disease-free) survival in the TSR high group was significantly better than in the TSR low group. By multivariate analysis, TSR was identified as a highly significant prognostic factor for overall survival (HR 2.0; P=0.010), independent of depth of tumour invasion, nodal status, lymph node ratio, extracapsular involvement, TNM stage, histological grade and radicality of resection.
  
  
  CONCLUSIONS
  TSR is a new and practicable prognostic tumour characteristic for oesophageal adenocarcinoma that can discriminate patients with a poor outcome from those with a better outcome.
authors.affiliation: Department of Surgical Oncology, the Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX Amsterdam, The Netherlands. e.courrech@nki.nl
authors.forename: Ewout F W
authors.initials: EF
authors.lastname: Courrech Staal
authors.forename: Michel W J M
authors.initials: MW
authors.lastname: Wouters
authors.forename: Johanna W
authors.initials: JW
authors.lastname: van Sandick
authors.forename: Marijn M
authors.initials: MM
authors.lastname: Takkenberg
authors.forename: Vincent T H B M
authors.initials: VT
authors.lastname: Smit
authors.forename: Jan M C
authors.initials: JM
authors.lastname: Junggeburt
authors.forename: Juliette M J
authors.initials: JM
authors.lastname: Spitzer-Naaykens
authors.forename: Tom
authors.initials: T
authors.lastname: Karsten
authors.forename: Henk H
authors.initials: HH
authors.lastname: Hartgrink
authors.forename: Wilma E
authors.initials: WE
authors.lastname: Mesker
authors.forename: Rob A E M
authors.initials: RA
authors.lastname: Tollenaar
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002454:Cell Differentiation; D004812:Epidemiologic Methods; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy / Q000379:methods; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D017154:Stromal Cells / Q000473:pathology; D016896:Treatment Outcome