title: Tumor-stroma ratio is an independent predictor for survival in esophageal squamous cell carcinoma.
abstract: OBJECTIVE
  Tumor-stroma ratio (TSR) has been identified as a new and practicable prognostic histological characteristic of solid tumors. The aim of this study was to evaluate the prognostic value of TSR in resected esophageal squamous cell carcinoma (ESCC).
  
  
  METHODS
  A total of 95 patients who underwent esophagectomy for ESCC were included in this study. TSR was assessed visually on the hematoxylin-eosin-stained tissue sections of surgical specimens by two independent observers. Patients with more than 50% intratumor stroma were quantified as the stroma-rich group and those with less than 50% as the stroma-poor group.
  
  
  RESULTS
  No significant differences were observed in patient, tumor, and treatment characteristics between the stroma-rich and stroma-poor groups. The 3-year overall survival and disease-free survival rates were 64% and 57%, respectively, in the stroma-poor group, and 23% and 23%, respectively, in the stroma-rich group. Both 3-year overall and disease-free survival rates in the stroma-poor group were significantly better than those in the stroma-rich group (p < 0.01). In a multivariate analysis, TSR was identified as a highly significant prognostic factor for 3-year overall survival (hazard ratio 3.450; p = 0.001) and 3-year disease-free survival (hazard ratio 2.995; p = 0.001), independent of pTNM stage and radicality of the primary tumor.
  
  
  CONCLUSIONS
  Stroma-rich tumors were associated with poor prognosis and an increased risk of relapse, which may serve as a new prognostic histological characteristic in ESCC. TSR is simple and quick to determine, is reproducible, and could be easily incorporated in routine histological evaluation.
authors: Oncology Center, Qilu Hospital of Shandong University, Jinan, People's Republic of China.
authors: Kai
authors: K
authors: Wang
authors: Wei
authors: W
authors: Ma
authors: Jianbo
authors: J
authors: Wang
authors: Liang
authors: L
authors: Yu
authors: Xiaomei
authors: X
authors: Zhang
authors: Zhenbo
authors: Z
authors: Wang
authors: Bingxu
authors: B
authors: Tan
authors: Nana
authors: N
authors: Wang
authors: Bing
authors: B
authors: Bai
authors: Shengsi
authors: S
authors: Yang
authors: Houqiang
authors: H
authors: Liu
authors: Shengjie
authors: S
authors: Zhu
authors: Yufeng
authors: Y
authors: Cheng
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D011379:Prognosis; D017154:Stromal Cells / Q000473:pathology*; D015996:Survival Rate