Results from the UNITED study: a multicenter study validating the prognostic effect of the tumor–stroma ratio in colon cancer

作者：M. Polack, Marloes A. Smit, Gabi W. van Pelt, Annet G.H. Roodvoets, Elma Meershoek‐Klein Kranenbarg, Hein Putter, Hans A. J. Gelderblom, A. Stijn L. P. Crobach, Valeska Terpstra, Gordana Petrushevska, Gorana Gašljević, Sanne Kjær‐Frifeldt, Erienne M.V. de Cuba, Nicole W.J. Bulkmans, Geraldine R. Vink, Raed Al Dieri, Rob A.�E.�M. Tollenaar, J. Han van Krieken, Wilma E. Mesker, Gordana Petrushevska, Magdalena Bogdanovska, Panche Zdravkoski, Svetozar Antović, Darko Dzambaz, Panche Karagjozov, Erienne M.V. de Cuba, Frédérique H. Beverdam, Jan B.�M.�J. Jansen, Maarten Vermaas, Gorana Gašljević, Sanne Kjær‐Frifeldt, Jan Lindebjerg, Maud Strous, Jeroen F. J. Vogelaar, Nicole W.J. Bulkmans, Joop van Baarlen, Leonie J. Mekenkamp, Ronald E. Hoekstra, Mark P.S. Sie, Míriam Cuatrecasas, Sara Simonetti, Maria Teresa Rodrigo‐Calvo, Ivan Archilla Sanz, José Pineda, Natalja E Leeuwis-Fedorovich, Koen Talsma, Ricella Souza da Silva, Miangela M. Laclé, Miriam Koopman, Jan Willem T. Dekker, Arjan van Tilburg, Paolo Giovanni Nuciforo, X. Villalobos Alberú, Stefania Landolfi, Adriana Zucchiatti, Emma Witteveen, Arad Bordbar, Mathijs P. Hendriks, René Arensman, Shonali Natu, Noori Maka, Wilma E. Mesker, Rob A.�E.�M. Tollenaar, Meaghan Polack, Marloes A. Smit, Gabi W. van Pelt, Hein Putter, Elma Meershoek-Kleinenbarg, Annet G.H. Roodvoets, A. Stijn L. P. Crobach, Hans A. J. Gelderblom, Mário Fontes e Sousa, Paula Borralho, João Cruz, Ana Raimundo, Nelson Silva, Maria João Brito, Valeska Terpstra, Л. М. Захарцева, Raed Al Dieri, Jean–François Fléjou, Roger M. Feakins, Els Dequeker, Geraldine R. Vink, J. Han van Krieken · 发表于：ESMO Open · 年份：2024 · DOI：10.1016/j.esmoop.2024.102988 · 被引用次数：28 · 研究领域：Colorectal Cancer Surgical Treatments、Colorectal Cancer Screening and Detection、Colorectal Cancer Treatments and Studies

BACKGROUND: The TNM (tumor-node-metastasis) Evaluation Committee of Union for International Cancer Control (UICC) and College of American Pathologists (CAP) recommended to prospectively validate the cost-effective and robust tumor-stroma ratio (TSR) as an independent prognostic parameter, since high intratumor stromal percentages have previously predicted poor patient-related outcomes. PATIENTS AND METHODS: The 'Uniform Noting for International application of Tumor-stroma ratio as Easy Diagnostic tool' (UNITED) study enrolled patients in 27 participating centers in 12 countries worldwide. The TSR, categorized as stroma-high (>50%) or stroma-low (≤50%), was scored through standardized microscopic assessment by certified pathologists, and effect on disease-free survival (DFS) was evaluated with 3-year median follow-up. Secondary endpoints were benefit assessment of adjuvant chemotherapy (ACT) and overall survival (OS). RESULTS: A total of 1537 patients were included, with 1388 eligible stage II/III patients curatively operated between 2015 and 2021. DFS was significantly shorter in stroma-high (n = 428) than in stroma-low patients (n = 960) (3-year rates 70% versus 83%; P < 0.001). In multivariate analysis, TSR remained an independent prognosticator for DFS (P < 0.001, hazard ratio 1.49, 95% confidence interval 1.17-1.90). As secondary outcome, DFS was also worse in stage II and III stroma-high patients despite adjuvant treatment (3-year rates stage II 73% versus 92% and stage ...