ArticleInternational journal of colorectal disease2021
Tumour-stroma ratio outperforms tumour budding as biomarker in colon cancer: a cohort study.
Article in International journal of colorectal disease, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it.
- A scoping review of TSR analysis in colorectal cancer: implications for automated solutions.Oncology reviews · 2025Pooled it
- Impact of stromal maturity and proportion on prognosis and immune landscape in colorectal cancer.Annals of medicine · 2026Article
- An Open Source Automated Tumor Infiltrating Lymphocytes Algorithm for Prognosis in Primary Small Bowel Adenocarcinoma Using Routine Hematoxylin and Eosin Stained Sections.Cancer medicine · 2026Article
- Integration of the GRIm Score with Pathologic Immune and Stromal Markers to Develop a Combined Prognostic Model in Gastric Cancer: A Retrospective Single-Center Study.Medicina (Kaunas, Lithuania) · 2026Article
- Automating tumor-stroma ratio quantification in colon cancer patients from the UNITED study.ESMO open · 2026Article
- Disease-Free Survival of Patients with Stage II Stroma-Rich Colorectal Adenocarcinomas with Microsatellite Stability.International journal of molecular sciences · 2025Article
- Article
- The tumour-stroma ratio as predictive aid towards a biopsy-based treatment strategy in rectal carcinoma.Histopathology · 2025Article
- Prognostic value of tumour-stroma ratio in nasopharyngeal carcinoma: a two-center retrospective study.Radiation oncology (London, England) · 2025Article
- Tumor‑stroma ratio as a clinical prognostic factor in colorectal carcinoma: A meta‑analysis of 7,934 patients.Oncology letters · 2025Article
- The Glasgow Microenvironment Score: an exemplar of contemporary biomarker evolution in colorectal cancer.The journal of pathology. Clinical research · 2024Review
- Unselective Measurement of Tumor-to-Stroma Proportion in Colon Cancer at the Invasion Front-An Elusive Prognostic Factor: Original Patient Data and Review of the Literature.Diagnostics (Basel, Switzerland) · 2024Article
- Results from the UNITED study: a multicenter study validating the prognostic effect of the tumor-stroma ratio in colon cancer.ESMO open · 2024Article
- Clinicopathological Significances of Peritumoral Budding in Colorectal Cancer: A Detailed Analysis Based on Mucinous and Micropapillary Pattern.Diagnostics (Basel, Switzerland) · 2023Article
- Article
- Tumor-stroma ratio predicts prognosis and PD-L1 expression in hepatocellular carcinoma.BMC cancer · 2023Article
- Tumor-Stroma Ratio in Colorectal Cancer-Comparison between Human Estimation and Automated Assessment.Cancers · 2023Article
- Correlation of Immunological and Histopathological Features with Gene Expression-Based Classifiers in Colon Cancer Patients.International journal of molecular sciences · 2022Article
- Tumor-Stroma Ratio and Programmed Cell Death Ligand 1 Expression in Preoperative Biopsy and Matched Laryngeal Carcinoma Surgical Specimen.International journal of molecular sciences · 2022Article
- Tumor Stroma Ratio and Its Significance in Locally Advanced Colorectal Cancer.Current oncology (Toronto, Ont.) · 2022Review
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7 authors.
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Abstract
The tumour-stroma ratio (TSR) and tumour budding (TB) are two high-risk factors with potential to be implemented in the next TNM classification. The aim of the current study was to evaluate the practical application of the two biomarkers based on reproducibility, independency and prognostic value. Patients diagnosed with stage II or III colon cancer who underwent surgery between 2005 and 2016 were included. Both TSR and TB were scored on haematoxylin and eosin-stained tissue sections. The TSR, based on the relative amount of stroma, was scored in increments of 10%. TB was scored following the consensus guidelines; a bud was defined as ≤ 4 tumour cells. For analysis, three categories were used. Cohen's kappa was used for reproducibility. The prognostic value was determined with survival analysis. In total, 246 patients were included. The TSR distribution was N = 137 (56%) stroma-low and N = 109 (44%) stroma-high. The TB distribution was TB-low N = 194 (79%), TB-intermediate N = 35 (14%) and TB-high N = 17 (7%). The reproducibility of the TSR was good (interobserver agreement kappa = 0.83 and intraobserver agreement kappa = 0.82), whereas the inter- and intraobserver agreement for scoring TB was moderate (kappa 0.47 and 0.45, respectively). The survival analysis showed an independent prognostic value for disease-free survival for TSR (HR 1.57; 95% CI 1.01-2.44; p = 0.048) and for TB-high (HR 2.01; 95% CI 1.02-3.96; p = 0.043). Based on current results, we suggest the TSR is a more reliable parameter in daily practice due to better reproducibility and independent prognostic value for disease-free survival.
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