Table 1 Summary of studies that reported tumor-stroma ratio (TSR) in head and neck cancer
First Author et al. Year (Country) | Tumor type | Stage | No. of cases | Stroma-rich cases (%) | Staining (Field) | Cutoff point | Main treatment | Main findings | Survival endpoint | Statistical values reporteda |
|---|---|---|---|---|---|---|---|---|---|---|
Zhang et al. 2014 (China) [11] | Nasopharyngeal | I-IV | 93 | 45.16% | HE (×10) | 50% | RT with or without CT | Stroma-rich tumors associated with poor prognosis | OS | HR 1.97 (1.10–3.55); P = 0.022 HR 1.99 (1.06–3.74); P = 0.030 |
DFS | HR 2.06 (1.15–3.71); P = 0.015 HR 1.92 (1.02–3.62); P = 0.042 | |||||||||
Niranjan et al. 2018 (India) [10] | Oral | I-III | 60 | 30% | HE (×10) | 50% | Surgery | TSR can be an adjuvant prognostic marker | OS | Survival rate was 77% in stroma-rich vs 95% in stroma-poor |
DFS | Survival rate was 44% in stroma-rich vs 69% in stroma-poor | |||||||||
Almangush et al. 2018 (Finland & Brazil) [12] | Oral tongue | I-II | 311 | 28.6% | HE (×10) | 50% | Surgery | Stroma-rich tumors associated with poor survival | DSS | HR 1.69 (1.02–2.79); P = 0.042 HR 1.71 (1.02–2.86); P = 0.03 |
DFS | HR 1.67 (1.09–2.56); P = 0.02 HR 1.81 (1.17–2.79); P = 0.008 | |||||||||
Karpathiou et al. 2019 (France) [15] | Laryngeal and pharyngeal | I-IV | 266 | 22.6% | HE (×10) | 50% | Surgery, and Neoadjuvant CT in 30% of cases | Stroma-rich tumors correlate with advanced stage and poor prognosis | OS | (1.27–2.59); P = 0.001 |
Karpathiou et al. 2020 (France) [21] | Laryngeal and pharyngeal | – | 99 | 21.2% | HE (×10) | 50%; also 30% | Surgery, and Neoadjuvant treatment | Stroma-rich tumors showed margin correlation with pretreatment measurements | NA | Correlation analysis of TSR with standardized uptake P = 0.07; and for metabolic tumor volume P = 0.1 |
Zhang et al. 2020 (China) [22] | Laryngeal | I-IV | 51 | 48.6% | HE (×10) | 50% | Surgery | TSR associated with poor survival. A significatint correlation between TSR and tumor budding was also reported | OS | P = 0.027 |
RFS | P = 0.031 | |||||||||
Dourado et al. 2020 (Brazil) [14] | Oral | I-IV | 254 | 44.1% | HE (×10) | 50% | Surgery, RT, CT | Stroma rich tumors associated with poor survival | DSS | HR 2.93 (1.89–4.52) P < 0.0001 HR 3.58 (2.05–6.27); P < 0.0001 |
DFS | HR 2.29 (1.40–3.76); P = 0.001 HR 2.05 (1.23–3.44); P = 0.006 | |||||||||
Bello et al. 2020 | Oral tongue | I-II | 84 | 31% | HE (×10) | 50% | Surgery | No significant difference in TSR between young and old patients | NA | NA |
Mascitti et al. 2020 (Italy) [13] | Oral tongue | I-IV | 211 | 19.43% | HE (×20) | 50% | Surgery alone or with adjuvant RT and CT | Stroma rich tumors associated with poor survival in oral tongue cancer | DSS | HR 1.68 (1.03–2.75); P = 0.036 |
OS | HR 1.69 (0.99–2.56); P = 0.051 | |||||||||
DFS | HR 1.65 (0.92–2.96); P = 0.111 |