Vangangelt Kiki M H, Tollenaar Lisanne S A, van Pelt Gabi W, de Kruijf Esther M, Dekker Tim J A, Kuppen Peter J K, Tollenaar Rob A E M, Mesker Wilma E
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Int J Cancer. 2018 Dec 15;143(12):3194-3200. doi: 10.1002/ijc.31658. Epub 2018 Oct 16.
The tumor-stroma ratio (TSR) has previously been found to be a strong prognostic parameter in primary breast cancer tumors. Since the presence of tumor cells in lymph nodes is important for clinical decision making, the influence of TSR in the primary breast tumor combined with the TSR in tumor-positive lymph nodes on prognosis was evaluated. Women with invasive breast cancer without distant metastasis who underwent an axillary lymph node dissection between 1985 and 1994 at the Leiden University Medical Center were retrospectively analyzed. TSR assessment was performed on hematoxylin and eosin stained tissue slides. In total, 87 (45.5%) primary tumors were scored as stroma-low and 104 (54.5%) as stroma-high. Patients with a high stromal percentage in the primary tumors had a statistically significant worse relapse free period (RFP) compared to stroma-low tumors (HR 1.97, 95% CI 1.37-2.82, p < 0.001). A total number of 915 lymph nodes were assessed for TSR. In 101 (52.9%) patients, heterogeneity was observed between stroma percentage category in primary tumor and lymph nodes. The combination of TSR of the primary tumor combined with TSR of tumor-positive lymph nodes strengthened each other as independent prognostic parameter for RFP (p = 0.019). Patients with primary tumor stroma-low/lymph nodes stroma-low tumors showed strongly improved RFP rates compared to patients with primary tumor stroma-high/lymph node stroma-high tumors with 10-year percentages of 58 versus 8%, respectively. Assessing the TSR on tumor-positive lymph nodes can provide additional prognostic information. Stromal activation strongly differs between primary tumors and lymph node metastasis.
肿瘤间质比（TSR）此前已被发现是原发性乳腺癌肿瘤的一个强有力的预后参数。由于淋巴结中肿瘤细胞的存在对临床决策很重要，因此评估了原发性乳腺肿瘤中的TSR与肿瘤阳性淋巴结中的TSR相结合对预后的影响。对1985年至1994年间在莱顿大学医学中心接受腋窝淋巴结清扫术的无远处转移的浸润性乳腺癌女性进行了回顾性分析。在苏木精和伊红染色的组织切片上进行TSR评估。总共87个（45.5%）原发性肿瘤被评为间质低，104个（54.5%）被评为间质高。与间质低的肿瘤相比，原发性肿瘤中间质百分比高的患者无复发生存期（RFP）在统计学上显著更差（风险比1.97，95%置信区间1.37 - 2.82，p < 0.001）。总共对915个淋巴结进行了TSR评估。在101名（52.9%）患者中，观察到原发性肿瘤和淋巴结之间的间质百分比类别存在异质性。原发性肿瘤的TSR与肿瘤阳性淋巴结的TSR相结合，作为RFP的独立预后参数相互增强（p = 0.019）。与原发性肿瘤间质高/淋巴结间质高的患者相比，原发性肿瘤间质低/淋巴结间质低的肿瘤患者的RFP率有显著提高，10年生存率分别为58%和8%。评估肿瘤阳性淋巴结的TSR可提供额外的预后信息。原发性肿瘤和淋巴结转移之间的间质激活差异很大。
