Prognostic impact of tumour-stroma ratio in early-stage oral tongue cancers

Abstract

Aims

Oral tongue squamous cell carcinoma (OTSCC) has a relatively poor outcome and there is a need to identify better prognostic factors. Recently, tumour-stroma ratio (TSR) has been associated with prognosis in several cancers. This multi-institutional study evaluates the prognostic value of TSR from original HE-stained tumor-resection slides in a series of early-stage (cT1-2N0) OTSCC patients.

Methods and results

A TSR cutoff value of 50% was used to divide the patients into stroma-rich (≥50%) and stroma-poor (<50%) groups. The relationships between TSR and clinicopathologic characteristics of 311 early-stage OTSCC cases were analyzed. The prognostic value of TSR in OTSCC was calculated separately and in combination with a previously published cancer cell budding and depth of invasion (BD) prognostic model. A total of 89 cases (28.6%) belonged to the stroma-rich group. In a multivariate analysis, the stroma-rich group had worse disease-free survival with a hazard ratio (HR) of 1.81 (95%CI 1.17-2.79, P= 0.008) and higher cancer-related mortality (HR 1.71, 95%CI 1.02-2.86, P= 0.03). The combination of the highest risk parameter scores of the TSR and the BD model showed a significant correlation with recurrence rate (HR 3.42, 95%CI 1.71-6.82, P= 0.004) and cancer-related mortality (HR 11.63, 95%CI 3.83-35.31, P< 0.001).

Conclusions

We conclude that TSR is a simple histopathologic feature useful for prognostication of early-stage OTSCC, and suggest that TSR analyses in association with BD score could be included in routine clinical pathology reports for HE-stained slides.

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