Tumour-stroma ratio and prognosis in gastric adenocarcinoma

Abstract Background: Tumour microenvironment, including tumour–stroma ratio (TSR), might help identifying high-risk cancer patients. However, the significance of TSR in gastric cancer is unclear, especially in the intestinal and diffuse subtypes. The aim of this study was to investigate the tumour–stroma ratio in gastric adenocarcinoma, and its intestinal and diffuse histological subtypes, in relation to prognosis. Methods: Five hundred and eighty-three gastric adenocarcinoma patients who underwent surgery in Oulu University hospital during years 1983–2016 were included in this retrospective cohort study. TSR was analysed from the slides that were originally used for diagnostic purposes. Patients were divided into stroma-poor (≤50% stroma) and stroma-rich (>50% stroma) groups and TSR was analysed in relation to 5-year mortality and overall mortality. Results: Patients with stroma-rich tumours had worse 5-year prognosis (HR 1.80, 95% CI 1.41–2.28) compared to stroma-poor tumours. Stratified analysis showed that stroma-rich tumours had worse 5-year prognosis in both intestinal (HR 1.68, 95% CI 1.24–2.27) and diffuse histological types (HR 2.09, 95% CI 1.35–3.23) compared to stroma-poor tumours, respectively. Conclusions: High proportion of stroma is an independent prognostic factor in both intestinal and diffuse histological subtypes of gastric adenocarcinoma