Tumor-stroma ratio is an independent predictor for survival in early cervical carcinoma.
OBJECTIVE
Tumor-stroma ratio (TSR) has recently been identified as an independent prognostic parameter for several solid tumors. The aim of the present study was to evaluate the prognostic role of TSR in early cervical cancer.


METHODS
A cohort of 184 patients who had surgery for early stage cervical cancer (FIGO [International Federation of Gynecology and Obstetrics] stages IA2-IIA) were enrolled in this study. TSR was estimated on hematoxylin-eosin-stained tissue sections from the most invasive part of the primary tumor. Patients with less than 50% stroma were classified as stroma-poor and patients with ≥ 50% stroma were classified as stroma-rich. The relationship between TSR and survival time was statistically analyzed.


RESULTS
The disease-free survival and overall survival rates were 88.44% and 92.52%, respectively, in the stroma-poor group, and 62.16% and 70.27%, respectively, in the stroma-rich group. Both the disease-free and overall survival rates in the stroma-poor group were significantly better than those in the stroma-rich group (p=0.001). In a multivariate analysis, TSR was further confirmed as a significant prognostic factor for disease-free survival (hazard ratio 3.125; p=0.005) and overall survival (hazard ratio 3.464; p=0.003), independent of tumor size, FIGO stage and lymph node metastasis.


CONCLUSIONS
Our study identified that TSR was an independent prognostic factor of early cervical cancer. Patients with stroma-rich tumors had worse prognosis and higher risk of relapse compared with those with stroma-poor tumors. Considering its simplicity and availability for conventional clinical pathology, TSR may serve as a new prognostic histological characteristic in early cervical cancer.
Department of Pathology, School of Medicine, Shandong University, Jinan, PR China.
Jing
J
Liu
Department of Microbiology and Key Laboratory for Experimental Teratology of Chinese Ministry of Education, School of Medicine, Shandong University, Jinan, PR China.
Juan
J
Liu
Department of Pathology, School of Medicine, Shandong University, Jinan, PR China.
Jinsong
J
Li
Department of Pathology, School of Medicine, Shandong University, Jinan, PR China.
Yingling
Y
Chen
Department of Endocrinology, Qianfoshan Hospital, Shandong University, Jinan, PR China.
Xiaoling
X
Guan
Department of Pathology, School of Medicine, Shandong University, Jinan, PR China.
Xiaojuan
X
Wu
Department of Pathology, School of Medicine, Shandong University, Jinan, PR China.
Chunyan
C
Hao
Department of Pathology, School of Medicine, Shandong University, Jinan, PR China.
Yanlin
Y
Sun
Department of Pathology, School of Medicine, Shandong University, Jinan, PR China.
Yan
Y
Wang
Department of Pathology, School of Medicine, Shandong University, Jinan, PR China. Electronic address: wangxiao08@sdu.edu.cn.
Xiao
X
Wang
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D002583:Uterine Cervical Neoplasms / Q000401:mortality* / Q000473:pathology*
Early cervical cancer; Survival; Tumor–stroma ratio