The prognostic value of tumor-stroma ratio in tumor-positive axillary lymph nodes of breast cancer patients

Abstract

The tumor–stroma ratio (TSR) has previously been found to be a strong prognostic parameter in primary breast cancer tumors.Since the presence of tumor cells in lymph nodes is important for clinical decision making, the influence of TSR in the primarybreast tumor combined with the TSR in tumor-positive lymph nodes on prognosis was evaluated. Women with invasive breastcancer without distant metastasis who underwent an axillary lymph node dissection between 1985 and 1994 at the LeidenUniversity Medical Center were retrospectively analyzed. TSR assessment was performed on hematoxylin and eosin stainedtissue slides. In total, 87 (45.5%) primary tumors were scored as stroma-low and 104 (54.5%) as stroma-high. Patients with ahigh stromal percentage in the primary tumors had a statistically significant worse relapse free period (RFP) compared tostroma-low tumors (HR 1.97, 95% CI 1.37–2.82, p < 0.001). A total number of 915 lymph nodes were assessed for TSR. In101 (52.9%) patients, heterogeneity was observed between stroma percentage category in primary tumor and lymph nodes.The combination of TSR of the primary tumor combined with TSR of tumor-positive lymph nodes strengthened each other asindependent prognostic parameter for RFP (p = 0.019). Patients with primary tumor stroma-low/lymph nodes stroma-lowtumors showed strongly improved RFP rates compared to patients with primary tumor stroma-high/lymph node stroma-hightumors with 10-year percentages of 58 versus 8%, respectively. Assessing the TSR on tumor-positive lymph nodes can provideadditional prognostic information. Stromal activation strongly differs between primary tumors and lymph node metastasis.