Tumor-stroma ratio (TSR) in non-small cell lung cancer (NSCLC) patients after lung resection is a prognostic factor for survival

Ke-Xing Xi, Ying-Sheng Wen, Chong-Mei Zhu, Xiang-Yang Yu, Rong-Qing Qin, Xue-Wen Zhang, Yong-Bin Lin, Tie-Hua Rong, Wei-Dong Wang, Yong-Qiang Chen, Lan-Jun Zhang


Background: In recent years, the tumor-stroma ratio (TSR) has been considered to a new and independent predictive variable for the prognosis of some kinds of neoplasms. The objective of this study was to assess the prognostic significance of the TSR in non-small cell lung cancer (NSCLC).
Methods: A cohort of 261 NSCLC patients who underwent radical surgery of lung cancer were included in the present study. Two independent observers visually estimated the TSR on hematoxylin-eosin (H&E) stained tissue pathological slices. According to the proportion of stroma ≥50% or <50%, We separate the patients into two groups: those with stroma-poor and those with stroma-rich tumors.
Results: Both univariate and multivariate analyses disclosed that the TSR was associated with overall survival (OS) [hazard ratio (HR), 1.741; 95% confidence intervals (CI), 1.040–2.913 and HR, 1.904; 95% CI, 1.132–3.202, respectively]. The HR values for disease-free survival (DFS) were 1.795 (95% CI, 1.073–3.005) and 2.034 (95% CI, 1.210–3.420). The OS and DFS of patients with stroma-poor tumors were better than those with stroma-rich tumors.
Conclusions: These results demonstrated that the TSR is a new prognostic factor for NSCLC. Stroma-poor tumors were associated with longer disease-free period and better prognosis than were stroma-rich tumors in NSCLC patients. The TSR may contribute to the development of individualized treatment for NSCLC in the future.