Lv Zhen, Cai Xianlei, Weng Xiaoyu, Xiao Heng, Du Chengli, Cheng Jun, Zhou Lin, Xie Haiyang, Sun Ke, Wu Jian, Zheng Shusen
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Collaborative Innovation Center of Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public, Hangzhou, China.
Surgery. 2015 Jul;158(1):142-50. doi: 10.1016/j.surg.2015.02.013. Epub 2015 Apr 15.
The stromal compartment in several organs seems to play an important role in the initiation, growth, and progression of certain neoplasms. The tumor-stroma ratio (TSR) has been found to be an independent factor for prognosis of several types of carcinomas, but the effect of the TSR on hepatocellular carcinoma (HCC) has not been explored yet. The objective of the study is to evaluate the prognostic importance of TSR in HCC patients after liver resection or transplantation.
A total of 300 patients with HCC who underwent liver resection or transplantation were included in this study. TSR was assessed on hematoxylin and eosin-stained sections by 2 independent investigators. Patients were divided into 2 groups: a stroma-rich group (stroma ≥ 50%) and a stroma-poor group (stroma < 50%). Chi-square test, Kaplan-Meier method, and Cox univariable and multivariable regression were used in to analyze the data.
Among the post liver resection patients, the TSR was associated with overall survival (OS) in univariate and multivariate analyses (hazard ratio [HR], 4.35 [95% CI, 2.54-7.47] and HR, 2.55 [95% CI, 1.44-4.52], respectively). Among the post liver transplant patients, the TSR was also associated with OS in univariate and multivariate analyses (HR, 2.92 [95% CI, 1.63-5.23] and HR, 2.76 [95% CI, 1.47-4.85], respectively), and TSR with recurrence-free survival (RFS) in univariate and multivariate analyses (HR, 2.63 [95% CI, 1.42-4.86] and HR, 1.93 [95% CI, 1.03-3.62], respectively). Patients with stroma-poor tumor and who were within the Milan criteria or the UCSF criteria had a better in OS and RFS.
We show for the first time that TSR is an independent prognostic factor for HCC patients after liver resection or transplantation. TSR may enable better identification of patients at risk for recurrence in HCC patients after curative treatment and may aid in patient management and development of individualized medicine for treatment of HCC.
多个器官中的基质成分似乎在某些肿瘤的起始、生长和进展中发挥重要作用。肿瘤-基质比（TSR）已被发现是几种类型癌症预后的独立因素，但TSR对肝细胞癌（HCC）的影响尚未得到研究。本研究的目的是评估TSR在肝癌患者肝切除或移植后的预后重要性。
本研究共纳入300例行肝切除或移植的HCC患者。由2名独立研究人员在苏木精和伊红染色切片上评估TSR。患者分为两组：基质丰富组（基质≥50%）和基质贫乏组（基质<50%）。采用卡方检验、Kaplan-Meier法以及Cox单变量和多变量回归分析数据。
在肝切除术后患者中，TSR在单变量和多变量分析中均与总生存期（OS）相关（风险比[HR]分别为4.35[95%CI，2.54 - 7.47]和HR 2.55[95%CI，1.44 - 4.52]）。在肝移植术后患者中，TSR在单变量和多变量分析中也与OS相关（HR分别为2.92[95%CI，1.63 - 5.23]和HR 2.76[95%CI，1.47 - 4.85]），且TSR在单变量和多变量分析中与无复发生存期（RFS）相关（HR分别为2.63[95%CI，1.42 - 4.86]和HR 1.93[95%CI，1.03 - 3.62]）。肿瘤基质贫乏且符合米兰标准或加州大学旧金山分校标准的患者OS和RFS更佳。
我们首次表明TSR是肝癌患者肝切除或移植后的独立预后因素。TSR可能有助于更好地识别根治性治疗后肝癌患者的复发风险，并可能有助于患者管理以及肝癌个体化治疗药物的开发。
