| Background:Lung cancer is the most lethal cancer worldwide due to its high incidence and mortality, of which the most common variant is non-small cell lung cancer (NSCLC). To date, the 5-year overall survival rate for patients with lung cancer is about 15%, highlighting the need for novel treatment strategies。 Based on the latest global cancer statistics, lung cancer accounted for about 13% of total cancer diagnoses and was the leading cause of cancer death among males。During the last decades, researchers have spared no effort to find prognostic factors, which could be used to predict disease control or survival。 Nevertheless, we cannot predict the relative risk for patients more precisely and define those at high risk of recurrence to receive individual treatment。Thus, identification of new prognostic factors is desirable for adequate determination of prognosis and therapeutic strategies。The prognostic factors of NSCLC include smoking history, tumor size, lymph node status, histology, and pTNM stage。 Although there are many well-established prognostic factors, it is still hard to predict the prognosis of individual patients accurately。Clinicians and researchers urgently need to identify economical and convenient predictors。Tumors are complex tissue composed of carcinoma cells and surrounding stroma。 It is increasingly acknowledged that tumor stroma is indispensable for cancer initiation, progression, and metastasis, and the stromal elements of tumor hold prognostic potential。Recently, the ratio of tumor to stroma (TSR) has been identified as a new and practical prognostic histologic characteristic of several solid tumors, such as esophageal cancer, breast cancer, colon cancer, and hepatocellular carcinoma。 However, the prognostic value of TSR has not been explored in detail or systematically for NSCLC。PurposesWe conducted the present study to evaluate the prognostic value of TSR in 404 patients with NSCLC and the relationship between TSR and other known prognostic parameters 。Methods404 patients with NSCLC who underwent complete surgery in Shandong Provincial Hospital affiliated to Shandong University. Shandong, China, from January 2007 to December 2009 were included in our stud 。 Expression of TSR was detected by HE in NSCLC tissue samples。 The cut-off of the TSR was taken as 50%。Patients with more than 50% intratumor stroma were quantified as the stroma-rich group and those with less than 50% as the stroma-poor group。Univariate and multivariate analysis were then performed to determine the relationship between expression of TSR and the clinical characteristics and to analyze whether expression of TSR was a significant independent prognostic factor for NSCLC patients。 Survival analysis and curves were established using the Kaplan-Meier method and the log-rank test was used to estimate differences in survival。ResultsIn 404 cases of tissue samples,302 cases were included in the stroma-poor group, while 102 cases in stroma-rich group。The different expression of TSR in NSCLC tissue was not correlated with gender, age, smoking history, tumor diameter, histology, differentiation grade and pTNM staging。 In the Cox univariate model, TSR, age, tumor diameter, differentiation grade and pTNM stage were significantly related to the 5-year OS and DFS. In the multivariate analysis, the TSR was an independent prognostic variable for the 5-year OS with an HR of 1.748 (95% CI; 1.262-2.422; P<0.05)。ConclusionTSR is a new independent prognostic factor for NSCLC o Stroma-rich tumors were associated with poor prognosis and an increased risk of relapse。... |
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