title: Prognostic significance of the tumor-stroma ratio: validation study in node-negative premenopausal breast cancer patients from the EORTC perioperative chemotherapy (POP) trial (10854).
abstract: The tumor-stroma ratio has previously been shown to be prognostic for patients with invasive breast cancer. We present a validation study to assess the prognostic significance in lymph node-negative, premenopausal patients from the perioperative chemotherapy trial (POP trial, 10854) conducted by the European Organization for Research and Treatment of Cancer. The POP trial assessed the efficacy of one course of perioperative chemotherapy (consisting of fluorouracil, doxorubicin, and cyclophosphamide). Hematoxylin and eosin (H&E) stained sections were retrieved from a subset of premenopausal, node-negative patients from this trial and were scored for the percentage of intra-tumoral stroma. The tumor-stroma ratio was associated with disease-free survival in univariate and multivariate analysis. Tumors with a high tumor-stroma ratio had an increased hazard of 1.853 for disease relapse (95 %CI 1.327-2.585, P < 0.001) independent of other parameters. Combining other parameters with the tumor-stroma ratio improved risk stratification. For triple-negative tumors, the tumor-stroma ratio was associated with an increased hazard for disease relapse, independent of other parameters (HR 2.711, 95 %CI 1.111-6.614, P = 0.028). The tumor-stroma ratio was also independently associated with locoregional recurrence even in breast cancer patients ≤40 years of age (HR 2.201, 95 %CI 1.038-4.669, P = 0.040). This study validates the prognostic value of the tumor-stroma ratio. This parameter can be easily assessed on HE slides and can be implemented next to pathological staging reports to determine patient prognosis.
authors.affiliation: Department of Surgery, Leiden University Medical Center, P.O. Box 9600 Albinusdreef, 2, 2300 RC, Leiden, The Netherlands. t.j.a.dekker@lumc.nl
authors.forename: T J A
authors.initials: TJ
authors.lastname: Dekker
authors.forename: C J H
authors.initials: CJ
authors.lastname: van de Velde
authors.forename: G W
authors.initials: GW
authors.lastname: van Pelt
authors.forename: J R
authors.initials: JR
authors.lastname: Kroep
authors.forename: J-P
authors.initials: JP
authors.lastname: Julien
authors.forename: V T H B M
authors.initials: VT
authors.lastname: Smit
authors.forename: R A E M
authors.initials: RA
authors.lastname: Tollenaar
authors.forename: W E
authors.initials: WE
authors.lastname: Mesker
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000378:metabolism; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D059035:Perioperative Period; D017697:Premenopause; D011379:Prognosis; D017154:Stromal Cells; D064726:Triple Negative Breast Neoplasms / Q000401:mortality / Q000473:pathology; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor