title: The proportion of tumour cells is an independent predictor for survival in colorectal cancer patients.
abstract: BACKGROUND
  The proportion of epithelial and stromal cells in tumours is thought to have an important role in the progression of epithelial malignancy. We aimed to determine whether the relative proportion of tumour (PoT) was related to survival in colorectal cancer.
  
  
  METHODS
  The PoT at the luminal surface was measured by point counting using virtual tissue sections in a series of 145 colorectal cancer cases. The relationship of PoT to clinicopathological parameters including cancer-specific survival was analysed. Modified receiver operating characteristic curves were used to determine the optimum cut off points to dichotomise the data for survival analyses.
  
  
  RESULTS
  Tumours with PoT-low (<or=47%) were associated with significantly lower cancer-specific survival when compared to PoT-high (hazard ratio (HR)=2.087, 95% CI=1.088-4.003, P=0.024). On sub-analysis, the prognostic effect remained significant in colonic tumours (HR=2.474, 95% CI=1.132-5.408, P=0.019) and tumour, node, metastasis stage III disease (HR=3.480, 95% CI=0.325-9.136, P=0.007). Multivariate Cox regression analysis demonstrated that PoT was an independent prognostic marker when adjusted for age, T stage, N stage and extramural vascular invasion (P=0.017).
  
  
  CONCLUSIONS
  This study suggests that a low proportion of tumour cells in colorectal cancer is related to poor cancer-specific survival. A relatively quick, inexpensive and well-established method such as point counting on diagnostic tissue sections could be used to identify a subset of patients who may benefit from adjuvant therapy.
authors.affiliation: Pathology and Tumour Biology, Leeds Institute of Molecular Medicine, University of Leeds, St James's University Hospital, Leeds LS9 7TF, UK.
authors.forename: N P
authors.initials: NP
authors.lastname: West
authors.forename: M
authors.initials: M
authors.lastname: Dattani
authors.forename: P
authors.initials: P
authors.lastname: McShane
authors.forename: G
authors.initials: G
authors.lastname: Hutchins
authors.forename: J
authors.initials: J
authors.lastname: Grabsch
authors.forename: W
authors.initials: W
authors.lastname: Mueller
authors.forename: D
authors.initials: D
authors.lastname: Treanor
authors.forename: P
authors.initials: P
authors.lastname: Quirke
authors.forename: H
authors.initials: H
authors.lastname: Grabsch
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology*; D000368:Aged; D019540:Area Under Curve; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012372:ROC Curve
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