Background: The tumor-stroma ratio (TSR) has been identified as a new and practicable prognostic histological characteristic of solid tumors. The aim of this study was to evaluate the prognostic value of the TSR in nasopharyngeal cancer (NPC). Patients and Methods: A total of 93 patients who presented with NPC from 2004 to 2007 were studied. Radiotherapy with or without chemotherapy was administered according to their Union for International Cancer Control (UICC) stages. The TSR was assessed visually on hematoxylin and eosin-stained tissue sections of biopsy specimens by 2 independent observers. Results: The 5-year overall survival (OS) and disease-free survival (DFS) rates were 66.67% and 54.91%, respectively, in the stroma-poor group and 40.48% and 33.33%, respectively, in the stroma-rich group. Both the 5-year OS and DFS rates in the stroma-poor group were significantly better than those in the stroma-rich group (p < 0.05). In a multivariate analysis, the TSR was identified as a highly significant prognostic factor for the 5-year OS (hazard ratio (HR) 1.999; p = 0.030) and the 5-year DFS (HR 1.925; p = 0.042). Conclusion: Stroma-rich tumors were associated with poor prognosis and an increased risk of relapse, which may serve as a new prognostic histological characteristic in NPC.

1.
de Kruijf EM, van Nes JG, van de Velde CJ, et al.: Tumor-stroma ratio in the primary tumor is a prognostic factor in early breast cancer patients, especially in triple-negative carcinoma patients. Breast Cancer Res Treat 2011;125:687-696.
[PubMed]
2.
Wang K, Ma W, Wang J, et al.: Tumor-stroma ratio is an independent predictor for survival in esophageal squamous cell carcinoma. J Thorac Oncol 2012;7:1457-1461.
[PubMed]
3.
Mesker WE, Junggeburt JM, Szuhai K, et al.: The carcinoma-stromal ratio of colon carcinoma is an independent factor for survival compared to lymph node status and tumor stage. Cell Oncol 2007;29:387-398.
[PubMed]
4.
Bremnes RM, Donnem T, Al-Saad S, et al.: The role of tumor stroma in cancer progression and prognosis: emphasis on carcinoma-associated fibroblasts and non-small cell lung cancer. J Thorac Oncol 2011;6:209-217.
[PubMed]
5.
Niedobitek G, Agathanggelou A, Nicholls JM: Epstein-Barr virus infection and the pathogenesis of nasopharyngeal carcinoma: viral gene expression, tumour cell phenotype, and the role of the lymphoid stroma. Semin Cancer Biol 1996;7:165-174.
[PubMed]
6.
Polyak K, Weinberg RA: Transitions between epithelial and mesenchymal states: acquisition of malignant and stem cell traits. Nat Rev Cancer 2009;9:265-273.
[PubMed]
7.
Sugimoto H, Mundel TM, Kieran MW, et al.: Identification of fibroblast heterogeneity in the tumor microenvironment. Cancer Biol Ther 2006;5:1640-1646.
[PubMed]
8.
Balsamo M, Scordamaglia F, Pietra G, et al.: Melanoma-associated fibroblasts modulate NK cell phenotype and antitumor cytotoxicity. Proc Natl Acad Sci USA 2009;106:20847-20852.
[PubMed]
9.
Gao Q, Wang XY, Qiu SJ, et al.: Tumor stroma reaction-related gene signature predicts clinical outcome in human hepatocellular carcinoma. Cancer Sci 2011;102:1522-1531.
[PubMed]
10.
Hwang RF, Moore T, Arumugam T, et al.: Cancer-associated stromal fibroblasts promote pancreatic tumor progression. Cancer Res 2008;68:918-926.
[PubMed]
11.
Kalluri R, Zeisberg M: Fibroblasts in cancer. Nat Rev Cancer 2006;6:392-401.
[PubMed]
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