Association between tumor-stroma ratio and prognosis in solid tumor patients: a systematic review and meta-analysis
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Jiayuan Wu1,*, Caixia Liang2, Manyu Chen2, Wenmei Su2,*
1Nutritional Department, The Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, China
2Department of Oncology, The Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, China
*These authors have contributed equally to this work
Jiayuan Wu, email: email@example.com
Wenmei Su, email: firstname.lastname@example.org
Keywords: tumor-stroma ratio, prognosis, clinicopathological features, solid tumors, meta-analysis
Received: June 30, 2016 Accepted: September 05, 2016 Published: September 20, 2016
Tumor-related stroma plays an active role in tumor invasion and metastasis. The tumor–stroma ratio (TSR) in the pathologic specimen has drawn increasing attention from the field of predicting tumor prognosis. However, the prognostic value of TSR in solid tumors necessitates further elucidation. We conducted a meta-analysis on 14 studies with 4238 patients through a comprehensive electronic search on databases updated on May 2016 to explore the relationship between TSR and prognosis of solid tumors. The overall hazard ratio showed that rich stroma in tumor tissue was associated with poor overall survival (OS) (14 studies, 4238 patients) and disease-free survival (DFS) (9 studies, 2235 patients) of patients with solid tumors. The effect of low TSR on poor OS was observed among various cancer types, but not in the early stage of cervical caner. A significant relationship between low TSR and poor OS was also observed in the subgroup analyses based on study region, blinding status, and Newcastle–Ottawa Scale (NOS) score. Subgroup analyses indicated that cancer type, clinical stage, study region, blinding status, and NOS score did not affect the prognostic value of TSR for DFS. Moreover, low TSR was significantly correlated with the serious clinical stage, advanced depth of invasion, and positive lymph node metastasis. These findings indicate that a high proportion of stroma in cancer tissue is associated with poor clinical outcomes in cancer patients, and TSR may serve as an independent prognostic factor for solid tumors.
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