دورية أكاديمية
Results from the UNITED study: a multicenter study validating the prognostic effect of the tumor-stroma ratio in colon cancer.
| العنوان: | Results from the UNITED study: a multicenter study validating the prognostic effect of the tumor-stroma ratio in colon cancer. |
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| المؤلفون: | Polack M; Department of Surgery, Leiden University Medical Center, Leiden., Smit MA; Department of Surgery, Leiden University Medical Center, Leiden., van Pelt GW; Department of Surgery, Leiden University Medical Center, Leiden., Roodvoets AGH; Clinical Research Center, Department of Surgery, Leiden University Medical Center, Leiden., Meershoek-Klein Kranenbarg E; Clinical Research Center, Department of Surgery, Leiden University Medical Center, Leiden., Putter H; Department of Biomedical Data Sciences, Leiden., Gelderblom H; Department of Medical Oncology, Leiden., Crobach ASLP; Department of Pathology, Leiden University Medical Center, Leiden., Terpstra V; Department of Pathology, Haaglanden Medical Center, The Hague, The Netherlands., Petrushevska G; Department of Pathology, Medical Faculty of Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia., Gašljević G; Department of Pathology, Onkološki inštitut-Institute of Oncology, Ljubljana, Slovenia., Kjær-Frifeldt S; Department of Pathology, Vejle Sygehus-Sygehus Lillebælt, Vejle, Denmark., de Cuba EMV; PATHAN Laboratories, Rotterdam, The Netherlands., Bulkmans NWJ; Department of Pathology, Spaarne Gasthuis, Haarlem., Vink GR; Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht; Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands., Al Dieri R; European Society of Pathology, Brussels, Belgium., Tollenaar RAEM; Department of Surgery, Leiden University Medical Center, Leiden., van Krieken JHJM; Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands., Mesker WE; Department of Surgery, Leiden University Medical Center, Leiden. Electronic address: w.e.mesker@lumc.nl. |
| مؤلفون مشاركون: | UNITED Collaboration |
| المصدر: | ESMO open [ESMO Open] 2024 Apr; Vol. 9 (4), pp. 102988. Date of Electronic Publication: 2024 Apr 12. |
| نوع المنشور: | Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: England NLM ID: 101690685 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2059-7029 (Electronic) Linking ISSN: 20597029 NLM ISO Abbreviation: ESMO Open Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2021 : [London] : Elsevier Original Publication: London : BMJ, [2016]- |
| مواضيع طبية MeSH: | Colonic Neoplasms*/pathology , Colonic Neoplasms*/mortality , Colonic Neoplasms*/drug therapy , Colonic Neoplasms*/therapy, Humans ; Female ; Male ; Middle Aged ; Aged ; Prognosis ; Stromal Cells/pathology ; Neoplasm Staging ; Prospective Studies ; Adult ; Disease-Free Survival ; Aged, 80 and over ; Chemotherapy, Adjuvant/methods |
| مستخلص: | 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 III 66% versus 80%; P = 0.008 and P = 0.011, respectively). In stage II patients not receiving ACT (n = 322), the TSR outperformed the American Society of Clinical Oncology (ASCO) criteria in identifying patients at risk of events (event rate 21% versus 9%), with a higher discriminatory 3-year DFS rate (stroma-high 80% versus ASCO high risk 91%). A trend toward worse 5-year OS in stroma-high was noticeable (74% versus 83% stroma-low; P = 0.102). Conclusion: The multicenter UNITED study unequivocally validates the TSR as an independent prognosticator, confirming worse outcomes in stroma-high patients. The TSR improved current selection criteria for patients at risk of events, and stroma-high patients potentially experienced chemotherapy resistance. TSR implementation in pathology diagnostics and international guidelines is highly recommended as aid in personalized treatment. (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.) |
| فهرسة مساهمة: | Investigator: G Petrushevska; M Bogdanovska; P Zdravkoski; S Antovic; D Dzambaz; P Karagjozov; EMV de Cuba; F Beverdam; J Jansen; M Vermaas; G Gašljević; S Kjær-Frifeldt; J Lindebjerg; M Strous; JF Vogelaar; NWJ Bulkmans; J van Baarlen; L Mekenkamp; R Hoekstra; M Sie; M Cuatrecasas; S Simonetti; MT Rodrigo; IA Sanz; J Guerrero Pineda; NE Leeuwis-Fedorovich; KA Talsma; RM Souza da Silva; MM Lacle; M Koopman; JWT Dekker; A van Tilburg; P Nuciforo; X Villalobos Alberú; S Landolfi; A Zucchiatti; E Witteveen; A Bordbar; MP Hendriks; R Arensman; S Natu; N Maka; WE Mesker; RAEM Tollenaar; M Polack; MA Smit; GW van Pelt; H Putter; E Meershoek-Kleinenbarg; AGH Roodvoets; ASLP Crobach; H Gelderblom; M Fontes E Sousa; P Borralho Nunes; J Cruz; A Raimundo; N Silva; MJ Brito; V Terpstra; LM Zakhartseva; R Al Dieri; JF Fléjou; R Feakins; E Dequeker; GR Vink; JHJM van Krieken Keywords: colon cancer; disease-free survival; pathology; tumor microenvironment; tumor–stroma ratio |
| تواريخ الأحداث: | Date Created: 20240413 Date Completed: 20240502 Latest Revision: 20240517 |
| رمز التحديث: | 20240518 |
| مُعرف محوري في PubMed: | PMC11033069 |
| DOI: | 10.1016/j.esmoop.2024.102988 |
| PMID: | 38613913 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 2059-7029 |
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| DOI: | 10.1016/j.esmoop.2024.102988 |