ArticleJournal of gastroenterology2018
The tumor-stromal ratio as a strong prognosticator for advanced gastric cancer patients: proposal of a new TSNM staging system.
Article in Journal of gastroenterology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 4 of them syntheses that pooled it.
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Who cites it
34 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- The Three Pillars of Glioblastoma: A Systematic Review and Novel Analysis of Multi-Omics and Clinical Data.Cells · 2024Pooled it
- Significance of Tumor-Stroma Ratio (TSR) in Predicting Outcomes of Malignant Tumors.Medicina (Kaunas, Lithuania) · 2023Pooled it
- Global updates in the treatment of gastric cancer: a systematic review. Part 1: staging, classification and surgical treatment.Updates in surgery · 2020Pooled it
- Tumour-stroma ratio and 5-year mortality in gastric adenocarcinoma: a systematic review and meta-analysis.Scientific reports · 2019Pooled it
- Added value of the tumor-stroma ratio to the PREDICT model for breast cancer.Breast (Edinburgh, Scotland) · 2026Article
- Association between fibroblast activation protein α expression and immune environment in gastric cancer.Oncology letters · 2026Article
- Tumor stroma ratio-based radiomics model for predicting platinum resistance and prognosis in epithelial ovarian cancer.Journal of ovarian research · 2026Article
- CT-derived extracellular volume fraction as a predictive marker for postoperative recurrence in pStage II-III gastric cancer.European radiology · 2026Article
- Assessing efficacy of anti-glypican-1 antibody-drug conjugate as potential therapeutic approach for gastric cancer.Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association · 2025Article
- E-cadherin expression and tumor-stroma ratio as prognostic biomarkers of peritoneal recurrence in advanced gastric cancer: a digital image analysis-based stratification study.Journal of pathology and translational medicine · 2025Article
- Tumor stroma ratio, tumor stroma maturity, tumor-infiltrating immune cells in relation to prognosis, and neoadjuvant therapy response in esophagogastric junction adenocarcinoma.Virchows Archiv : an international journal of pathology · 2025Article
- Tumor-Stroma Ratio is a Critical Indicator of Peritoneal Metastasis in Gastric Cancer.Clinical and experimental gastroenterology · 2025Article
- Prediction of long-term survival in gastric cancer patients after immunotherapy based on CT-derived extracellular volume fraction.Frontiers in oncology · 2025Article
- Tumor microenvironment characteristics association with clinical outcome in patients with resected intestinal-type gastric cancer.The oncologist · 2024Article
- A predictive model and rapid multi-dynamic algorithm developed based on tumor-stroma percentage in gastric cancer: a retrospective, observational study.Gastroenterology report · 2024Article
- GBP2 is a prognostic biomarker and associated with immunotherapeutic responses in gastric cancer.BMC cancer · 2023Article
- Article
- The Pan-Cancer Crosstalk Between theFrontiers in cell and developmental biology · 2022Article
- Article
- Multiparametric MRI-based radiomics signature for preoperative estimation of tumor-stroma ratio in rectal cancer.European radiology · 2021Article
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4 authors.
Funding
Abstract
backgroundInsufficient attention is paid to the underlying tumor microenvironment (TME) evolution, that resulting in tumor heterogeneity and driving differences in cancer aggressiveness and treatment outcomes. The morphological evaluation of the proportion of the stroma at the most invasive part of primary tumor (tumor-stromal ratio, TSR) in cancer is gaining momentum as evidence strengthens for the clinical relevance.
methodsTissue samples from the most invasive part of the primary gastric cancer (GC) of 494 patients were analyzed for their TSR, and a new TSNM (tumor-stromal node metastasis) staging system based on patho-biological behaviors was established and assessed.
resultsTSR is a new and strong independent prognostic factor for GC patients. The likelihood of tumor invasion is increased significantly for patients in the stromal-high subgroup compared to those in the stromal-low subgroup (P = 0.011). The discrimination ability of TSR was not less than the TNM staging system and was better in patients with stages I and II GC. We integrated the TSR parameter into the TNM staging system and proposed a new TSNM staging system creatively. There were three new subgroups (IC, IIC, IIID). There were four major groups and 10 subgroups in the TSNM system. The difference in overall survival (OS) was statistically significant among all TSNM system (P < 0.005 for all). Deep analyses revealed well predictive performance of the TSNM (P < 0.001).
conclusionsThis study confirms the TSR as a TME prognostic factor for GC. TSR is a candidate TME parameter that could easily be implemented in routine pathology diagnostics, and the TSNM staging system has been established to optimize risk stratification for GC. The value of the TSNM staging system should be validated in further prospective study.
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