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Reitsam NG, Grosser B, Enke JS, Mueller W, Westwood A, West NP, Quirke P, Märkl B, Grabsch HI. Stroma AReactive Invasion Front Areas (SARIFA): a novel histopathologic biomarker in colorectal cancer patients and its association with the luminal tumour proportion. Transl Oncol 2024; 44:101913. [PMID: 38593584 PMCID: PMC11024380 DOI: 10.1016/j.tranon.2024.101913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Stroma AReactive Invasion Front Areas (SARIFA) is a novel prognostic histopathologic biomarker measured at the invasive front in haematoxylin & eosin (H&E) stained colon and gastric cancer resection specimens. The aim of the current study was to validate the prognostic relevance of SARIFA-status in colorectal cancer (CRC) patients and investigate its association with the luminal proportion of tumour (PoT). METHODS We established the SARIFA-status in 164 CRC resection specimens. The relationship between SARIFA-status, clinicopathological characteristics, recurrence-free survival (RFS), cancer-specific survival (CSS), and PoT was investigated. RESULTS SARIFA-status was positive in 22.6% of all CRCs. SARIFA-positivity was related to higher pT, pN, pTNM stage and high grade of differentiation. SARIFA-positivity was associated with shorter RFS independent of known prognostic factors analysing all CRCs (RFS: hazard ratio (HR) 2.6, p = 0.032, CSS: HR 2.4, p = 0.05) and shorter RFS and CSS analysing only rectal cancers. SARIFA-positivity, which was measured at the invasive front, was associated with PoT-low (p = 0.009), e.g., higher stroma content, and lower vessel density (p = 0.0059) measured at the luminal tumour surface. CONCLUSION Here, we validated the relationship between SARIFA-status and prognosis in CRC patients and provided first evidence for a potential prognostic relevance in the subgroup of rectal cancer patients. Interestingly, CRCs with different SARIFA-status also showed histological differences measurable at the luminal tumour surface. Further studies to better understand the relationship between high luminal intratumoural stroma content and absence of a stroma reaction at the invasive front (SARIFA-positivity) are warranted and may inform future treatment decisions in CRC patients.
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Affiliation(s)
- N G Reitsam
- Pathology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - B Grosser
- Pathology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - J S Enke
- Nuclear Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - W Mueller
- Gemeinschaftspraxis Pathologie, Starnberg, Germany
| | - A Westwood
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's University, University of Leeds, Leeds, UK
| | - N P West
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's University, University of Leeds, Leeds, UK
| | - P Quirke
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's University, University of Leeds, Leeds, UK
| | - B Märkl
- Pathology, Faculty of Medicine, University of Augsburg, Augsburg, Germany.
| | - H I Grabsch
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's University, University of Leeds, Leeds, UK; Department of Pathology, GROW - Research Institute for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands.
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Fekete Z, Ignat P, Resiga AC, Todor N, Muntean AS, Resiga L, Curcean S, Lazar G, Gherman A, Eniu D. Unselective Measurement of Tumor-to-Stroma Proportion in Colon Cancer at the Invasion Front-An Elusive Prognostic Factor: Original Patient Data and Review of the Literature. Diagnostics (Basel) 2024; 14:836. [PMID: 38667481 PMCID: PMC11049389 DOI: 10.3390/diagnostics14080836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
The tumor-to-stroma ratio is a highly debated prognostic factor in the management of several solid tumors and there is no universal agreement on its practicality. In our study, we proposed confirming or dismissing the hypothesis that a simple measurement of stroma quantity is an easy-to-use and strong prognostic tool. We have included 74 consecutive patients with colorectal cancer who underwent primary curative abdominal surgery. The tumors have been grouped into stroma-poor (stroma < 10%), medium-stroma (between 10 and 50%) and stroma-rich (over 50%). The proportion of tumor stroma ranged from 5% to 70% with a median of 25%. Very few, only 6.8% of patients, had stroma-rich tumors, 4% had stroma-poor tumors and 89.2% had tumors with a medium quantity of stroma. The proportion of stroma, at any cut-off, had no statistically significant influence on the disease-specific survival. This can be explained by the low proportion of stroma-rich tumors in our patient group and the inverse correlation between stroma proportion and tumor grade. The real-life proportion of stroma-rich tumors and the complex nature of the stroma-tumor interaction has to be further elucidated.
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Affiliation(s)
- Zsolt Fekete
- Department of Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (P.I.); (S.C.); (G.L.); (A.G.); (D.E.)
- “Prof. Dr. I. Chiricuță” Oncology Institute, 400015 Cluj-Napoca, Romania; (N.T.); (A.-S.M.); (L.R.)
| | - Patricia Ignat
- Department of Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (P.I.); (S.C.); (G.L.); (A.G.); (D.E.)
- “Prof. Dr. I. Chiricuță” Oncology Institute, 400015 Cluj-Napoca, Romania; (N.T.); (A.-S.M.); (L.R.)
| | | | - Nicolae Todor
- “Prof. Dr. I. Chiricuță” Oncology Institute, 400015 Cluj-Napoca, Romania; (N.T.); (A.-S.M.); (L.R.)
| | - Alina-Simona Muntean
- “Prof. Dr. I. Chiricuță” Oncology Institute, 400015 Cluj-Napoca, Romania; (N.T.); (A.-S.M.); (L.R.)
| | - Liliana Resiga
- “Prof. Dr. I. Chiricuță” Oncology Institute, 400015 Cluj-Napoca, Romania; (N.T.); (A.-S.M.); (L.R.)
| | - Sebastian Curcean
- Department of Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (P.I.); (S.C.); (G.L.); (A.G.); (D.E.)
- “Prof. Dr. I. Chiricuță” Oncology Institute, 400015 Cluj-Napoca, Romania; (N.T.); (A.-S.M.); (L.R.)
| | - Gabriel Lazar
- Department of Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (P.I.); (S.C.); (G.L.); (A.G.); (D.E.)
| | - Alexandra Gherman
- Department of Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (P.I.); (S.C.); (G.L.); (A.G.); (D.E.)
- “Prof. Dr. I. Chiricuță” Oncology Institute, 400015 Cluj-Napoca, Romania; (N.T.); (A.-S.M.); (L.R.)
| | - Dan Eniu
- Department of Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (P.I.); (S.C.); (G.L.); (A.G.); (D.E.)
- Nicolae Stăncioiu Heart Institute, 400001 Cluj-Napoca, Romania;
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Souza D, Queiroga E, de T, Cunha K, Dias E. Stromal scoring in advanced colon and rectal cancer: Stroma-rich tumors and their association with aggressive phenotypes. Arch Oncol 2022; 28:1-6. [DOI: 10.2298/aoo210403003s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Our aim was to explore relevance of the proportion between neoplastic cell component and tumor-associated stroma in order to assess its association with confirmed aggressive phenotypes of right/left colon and rectum cancers in a large series of patients. Methods: The quantification of stroma component was performed in patients diagnosed with colorectal adenocarcinoma who underwent surgical resection. The analyzed variables were age, gender, anatomical/pathological features, and tumor-stroma proportion. Tumor-stroma proportion was estimated based on slides used in routine pathology for determination of T status and was described as low, with a stromal percentage ?50% or high, with a stromal percentage >50%. The tumor-stroma proportion was estimated by two observers, and the inter-observer agreement was assessed. Results: The sample included 390 colorectal adenocarcinoma patients. Stroma-rich tumors were observed in 53.3% of cases. Well-differentiated tumors had the lowest stromal proportions (p = 0.028). Stroma-poor tumors showed less depth of invasion (p<0.001). High stromal content was observed in association with tumor budding, perineural, angiolymphatic, and lymph node involvement, and distant metastasis (p?0.001). Colorectal adenocarcinoma without lymph node or distant metastasis involvement had lower stromal proportion, while metastatic ones exhibited high stromal content (p <0.001). The inter-rater reliability (concordance) between the estimations of pathologists for tumor-stroma proportions was high (?=0.746). Conclusion: The tumorstroma proportion in colorectal adenocarcinoma was associated with adverse prognostic factors, reflecting the stage of the disease. Stroma-rich tumors showed a significant correlation with advancement of the disease and its aggressiveness. Due to its availability tumor-stroma proportion evaluation has high application potential and can complement current staging system for colorectal adenocarcinoma.
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Gao J, Shen Z, Deng Z, Mei L. Impact of Tumor-Stroma Ratio on the Prognosis of Colorectal Cancer: A Systematic Review. Front Oncol 2021; 11:738080. [PMID: 34868930 PMCID: PMC8635241 DOI: 10.3389/fonc.2021.738080] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/22/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND It is critical to develop a reliable and cost-effective prognostic tool for colorectal cancer (CRC) stratification and treatment optimization. Tumor-stroma ratio (TSR) may be a promising indicator of poor prognosis in CRC patients. As a result, we conducted a systematic review on the predictive value of TSR in CRC. METHODS This study was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guideline. An electronic search was completed using commonly used databases PubMed, CENTRAL, Cochrane Central Register of Controlled Trials, and Google scholar till the last search up to May 30, 2021. STATA version 13 was used to analyze the data. RESULTS A total of 13 studies [(12 for disease-free survival (DFS) and nine studies for overall survival (OS)] involving 4,857 patients met the inclusion criteria for the systematic review in the present study. In individuals with stage II CRC, stage III CRC, or mixed stage CRC, we observed a significantly higher pooled hazard ratio (HR) in those with a low TSR/greater stromal content (HR, 1.54; 95% CI: 1.20 to 1.88), (HR, 1.90; 95% CI: 1.35 to 2.45), and (HR, 1.70; 95% CI: 1.45 to 1.95), respectively, for predicting DFS. We found that a low TSR ratio had a statistically significant predictive relevance for stage II (HR, 1.43; 95% CI: 1.09 to 1.77) and mixed stages of CRC (HR, 1.65; 95% CI: 1.31 to 2.0) for outcome OS. CONCLUSION In patients with CRC, low TSR was found to be a prognostic factor for a worse prognosis (DFS and OS).
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Affiliation(s)
- Jinlai Gao
- Department of Pathology, Huzhou Maternity and Child Health Care Hospital, Huzhou, China
| | - Zhangguo Shen
- School of Information Engineering, Huzhou University, Huzhou, China
| | - Zaixing Deng
- Department of Pathology, Huzhou Maternity and Child Health Care Hospital, Huzhou, China
| | - Lina Mei
- Department of Internal Medicine, Huzhou Maternity and Child Health Care Hospital, Huzhou, China
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Xu Z, Li Y, Wang Y, Zhang S, Huang Y, Yao S, Han C, Pan X, Shi Z, Mao Y, Xu Y, Huang X, Lin H, Chen X, Liang C, Li Z, Zhao K, Zhang Q, Liu Z. A deep learning quantified stroma-immune score to predict survival of patients with stage II-III colorectal cancer. Cancer Cell Int 2021; 21:585. [PMID: 34717647 PMCID: PMC8557607 DOI: 10.1186/s12935-021-02297-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/23/2021] [Indexed: 12/24/2022] Open
Abstract
Background Profound heterogeneity in prognosis has been observed in colorectal cancer (CRC) patients with intermediate levels of disease (stage II–III), advocating the identification of valuable biomarkers that could improve the prognostic stratification. This study aims to develop a deep learning-based pipeline for fully automatic quantification of immune infiltration within the stroma region on immunohistochemical (IHC) whole-slide images (WSIs) and further analyze its prognostic value in CRC. Methods Patients from two independent cohorts were divided into three groups: the development group (N = 200), the internal (N = 134), and the external validation group (N = 90). We trained a convolutional neural network for tissue classification of CD3 and CD8 stained WSIs. A scoring system, named stroma-immune score, was established by quantifying the density of CD3+ and CD8+ T-cells infiltration in the stroma region. Results Patients with higher stroma-immune scores had much longer survival. In the development group, 5-year survival rates of the low and high scores were 55.7% and 80.8% (hazard ratio [HR] for high vs. low 0.39, 95% confidence interval [CI] 0.24–0.63, P < 0.001). These results were confirmed in the internal and external validation groups with 5-year survival rates of low and high scores were 57.1% and 78.8%, 63.9% and 88.9%, respectively (internal: HR for high vs. low 0.49, 95% CI 0.28–0.88, P = 0.017; external: HR for high vs. low 0.35, 95% CI 0.15–0.83, P = 0.018). The combination of stroma-immune score and tumor-node-metastasis (TNM) stage showed better discrimination ability for survival prediction than using the TNM stage alone. Conclusions We proposed a stroma-immune score via a deep learning-based pipeline to quantify CD3+ and CD8+ T-cells densities within the stroma region on WSIs of CRC and further predict survival. Supplementary Information The online version contains supplementary material available at 10.1186/s12935-021-02297-w.
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Affiliation(s)
- Zeyan Xu
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China.,School of Medicine, South China University of Technology, Panyu District, Guangzhou, 510006, China
| | - Yong Li
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Yingyi Wang
- Department of Radiology, Zhuhai People's Hospital, Zhuhai Hospital Affiliated with Jinan University, Zhuhai, 519000, China
| | - Shenyan Zhang
- Department of Pathology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Yanqi Huang
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Su Yao
- Department of Pathology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Chu Han
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Xipeng Pan
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Zhenwei Shi
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Yun Mao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yao Xu
- School of Bioengineering, Chongqing University, Chongqing, 400044, China
| | - Xiaomei Huang
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510080, China
| | - Huan Lin
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China.,School of Medicine, South China University of Technology, Panyu District, Guangzhou, 510006, China
| | - Xin Chen
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou, 510180, China
| | - Changhong Liang
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Zhenhui Li
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China. .,Department of Pathology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China.
| | - Ke Zhao
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China.
| | - Qingling Zhang
- Department of Pathology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
| | - Zaiyi Liu
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China. .,School of Medicine, South China University of Technology, Panyu District, Guangzhou, 510006, China.
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Martin B, Gonçalves JPL, Bollwein C, Sommer F, Schenkirsch G, Jacob A, Seibert A, Weichert W, Märkl B, Schwamborn K. A Mass Spectrometry Imaging Based Approach for Prognosis Prediction in UICC Stage I/II Colon Cancer. Cancers (Basel) 2021; 13:5371. [PMID: 34771536 DOI: 10.3390/cancers13215371] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Tumor treatment is heavily dictated by the tumor progression status. However, in colon cancer, it is difficult to predict disease progression in the early stages. In this study, we have employed a proteomic analysis using matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI-MSI). MALDI-MSI is a technique that measures the molecular content of (tumor) tissue. We analyzed tumor samples of 276 patients. If the patients developed distant metastasis, they were considered to have a more aggressive tumor type than the patients that did not. In this comparative study, we have developed bioinformatics methods that can predict the tendency of tumor progression and advance a couple of molecules that could be used as prognostic markers of colon cancer. The prediction of tumor progression can help to choose a more adequate treatment for each individual patient. Abstract Currently, pathological evaluation of stage I/II colon cancer, following the Union Internationale Contre Le Cancer (UICC) guidelines, is insufficient to identify patients that would benefit from adjuvant treatment. In our study, we analyzed tissue samples from 276 patients with colon cancer utilizing mass spectrometry imaging. Two distinct approaches are herein presented for data processing and analysis. In one approach, four different machine learning algorithms were applied to predict the tendency to develop metastasis, which yielded accuracies over 90% for three of the models. In the other approach, 1007 m/z features were evaluated with regards to their prognostic capabilities, yielding two m/z features as promising prognostic markers. One feature was identified as a fragment from collagen (collagen 3A1), hinting that a higher collagen content within the tumor is associated with poorer outcomes. Identification of proteins that reflect changes in the tumor and its microenvironment could give a very much-needed prediction of a patient’s prognosis, and subsequently assist in the choice of a more adequate treatment.
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Miller S, Bauer S, Schrempf M, Schenkirsch G, Probst A, Märkl B, Martin B. Semiautomatic analysis of tumor proportion in colon cancer: Lessons from a validation study. Pathol Res Pract 2021; 227:153634. [PMID: 34628263 DOI: 10.1016/j.prp.2021.153634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/15/2022]
Abstract
The tumor stroma ratio (TSR) is a promising histopathologic prognostic biomarker, which could allow for more accurate risk stratification and improved patient management in colorectal cancer. The purpose of our research was to validate the results of a previous study, which had suggested that not only a low but also a high tumor proportion (TP) might be an independent risk factor for occurrence of distant metastasis and worse overall survival using a semiautomatic image analysis approach with the open-source software ImageJ. We investigated 253 pT3 and pT4 adenocarcinomas of no special type. The previously established thresholds (PES-cut-offs) used to classify the patients (previous 3-tiered-classification) according to the tumor proportion (TP) in a highTP (TP ≥ 54%), a mediumTP (TP < 54% ∩ TP >15%) and a lowTP (TP ≤ 15%) group did not show a significant risk stratification. Even the adjustment of these threshold revealed no significant results. Therefore, a receiver-operating characteristic (ROC) analysis was performed to establish the cut-off with the most significant predictive power and a "new 2-tiered-classification" using this cut-off (40% at MinTP) showed a significantly shorter absence of metastasis for patients with a low TP (p = 0.007). These results confirm that a low TP is associated with an adverse prognosis. This study did not confirm the previous assumption that a high TP might also be a risk factor for occurrence of metastasis. Furthermore, it demonstrates that this semiautomatic technique is not superior to the established method, so that approaches to enhance prognostic techniques should continue.
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Affiliation(s)
- Silvia Miller
- General Pathology and Molecular Diagnostics, Medical Faculty Augsburg, University Augsburg, Germany
| | - Svenja Bauer
- General Pathology and Molecular Diagnostics, Medical Faculty Augsburg, University Augsburg, Germany
| | - Matthias Schrempf
- Department of Visceral Surgery, University Hospital Augsburg, Augsburg, Germany
| | | | - Andreas Probst
- Medicine III - Gastroenterology, Medical Faculty Augsburg, University Augsburg, Germany
| | - Bruno Märkl
- General Pathology and Molecular Diagnostics, Medical Faculty Augsburg, University Augsburg, Germany.
| | - Benedikt Martin
- General Pathology and Molecular Diagnostics, Medical Faculty Augsburg, University Augsburg, Germany
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Martin B, Grosser B, Kempkens L, Miller S, Bauer S, Dhillon C, Banner BM, Brendel EM, Sipos É, Vlasenko D, Schenkirsch G, Schiele S, Müller G, Märkl B. Stroma AReactive Invasion Front Areas (SARIFA)-A New Easily to Determine Biomarker in Colon Cancer-Results of a Retrospective Study. Cancers (Basel) 2021; 13:cancers13194880. [PMID: 34638364 PMCID: PMC8508517 DOI: 10.3390/cancers13194880] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/22/2021] [Accepted: 09/25/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Many studies have used histomorphological features to more precisely predict the prognosis of patients with colon cancer, focusing on tumor budding, poorly differentiated clusters, and the tumor–stroma ratio. Here, we introduce SARIFA: Stroma AReactive Invasion Front Area(s). We defined SARIFA as the direct contact between a tumor gland/tumor cell cluster (≥5 cells) and inconspicuous surrounding adipose tissue in the invasion front. SARIFA shows an excellent interobserver reliability and high prognostic value and is thus a promising histomorphological prognostic indicator for adipose-infiltrative adenocarcinomas of the colon. Abstract Many studies have used histomorphological features to more precisely predict the prognosis of patients with colon cancer, focusing on tumor budding, poorly differentiated clusters, and the tumor–stroma ratio. Here, we introduce SARIFA: Stroma AReactive Invasion Front Area(s). We defined SARIFA as the direct contact between a tumor gland/tumor cell cluster (≥5 cells) and inconspicuous surrounding adipose tissue in the invasion front. In this retrospective, single-center study, we classified 449 adipose-infiltrative adenocarcinomas (not otherwise specified) from two groups based on SARIFA and found 25% of all tumors to be SARIFA-positive. Kappa values between the two pathologists were good/very good: 0.77 and 0.87. Patients with SARIFA-positive tumors had a significantly shorter colon-cancer-specific survival (p = 0.008, group A), absence of metastasis, and overall survival (p < 0.001, p = 0.003, group B). SARIFA was significantly associated with adverse features such as pT4 stage, lymph node metastasis, tumor budding, and higher tumor grade. Moreover, SARIFA was confirmed as an independent prognostic indicator for colon-cancer-specific survival (p = 0.011, group A). SARIFA assessment was very quick (<1 min). Because of low interobserver variability and good prognostic significance, SARIFA seems to be a promising histomorphological prognostic indicator in adipose-infiltrative adenocarcinomas of the colon. Further studies should validate our results and also determine whether SARIFA is a universal prognostic indicator in solid cancers.
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Affiliation(s)
- Benedikt Martin
- General Pathology and Molecular Diagnostics, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany; (B.M.); (B.G.); (L.K.); (S.M.); (S.B.); (C.D.); (B.M.B.); (E.-M.B.); (É.S.)
| | - Bianca Grosser
- General Pathology and Molecular Diagnostics, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany; (B.M.); (B.G.); (L.K.); (S.M.); (S.B.); (C.D.); (B.M.B.); (E.-M.B.); (É.S.)
| | - Lana Kempkens
- General Pathology and Molecular Diagnostics, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany; (B.M.); (B.G.); (L.K.); (S.M.); (S.B.); (C.D.); (B.M.B.); (E.-M.B.); (É.S.)
| | - Silvia Miller
- General Pathology and Molecular Diagnostics, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany; (B.M.); (B.G.); (L.K.); (S.M.); (S.B.); (C.D.); (B.M.B.); (E.-M.B.); (É.S.)
| | - Svenja Bauer
- General Pathology and Molecular Diagnostics, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany; (B.M.); (B.G.); (L.K.); (S.M.); (S.B.); (C.D.); (B.M.B.); (E.-M.B.); (É.S.)
| | - Christine Dhillon
- General Pathology and Molecular Diagnostics, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany; (B.M.); (B.G.); (L.K.); (S.M.); (S.B.); (C.D.); (B.M.B.); (E.-M.B.); (É.S.)
| | - Bettina Monika Banner
- General Pathology and Molecular Diagnostics, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany; (B.M.); (B.G.); (L.K.); (S.M.); (S.B.); (C.D.); (B.M.B.); (E.-M.B.); (É.S.)
| | - Eva-Maria Brendel
- General Pathology and Molecular Diagnostics, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany; (B.M.); (B.G.); (L.K.); (S.M.); (S.B.); (C.D.); (B.M.B.); (E.-M.B.); (É.S.)
| | - Éva Sipos
- General Pathology and Molecular Diagnostics, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany; (B.M.); (B.G.); (L.K.); (S.M.); (S.B.); (C.D.); (B.M.B.); (E.-M.B.); (É.S.)
| | - Dmytro Vlasenko
- General, Visceral and Transplantation Surgery, University Hospital of Augsburg, 86156 Augsburg, Germany;
| | - Gerhard Schenkirsch
- Tumor Data Management, University Hospital Augsburg, 86156 Augsburg, Germany;
| | - Stefan Schiele
- Institute of Mathematics, Augsburg University, 86156 Augsburg, Germany; (S.S.); (G.M.)
| | - Gernot Müller
- Institute of Mathematics, Augsburg University, 86156 Augsburg, Germany; (S.S.); (G.M.)
| | - Bruno Märkl
- General Pathology and Molecular Diagnostics, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany; (B.M.); (B.G.); (L.K.); (S.M.); (S.B.); (C.D.); (B.M.B.); (E.-M.B.); (É.S.)
- Correspondence: ; Tel.: +49-8214002150
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9
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Li T, Yu Z, Yang Y, Fu Z, Chen Z, Li Q, Zhang K, Luo Z, Qiu Z, Huang C. Rapid multi-dynamic algorithm for gray image analysis of the stroma percentage on colorectal cancer. J Cancer 2021; 12:4561-4573. [PMID: 34149920 PMCID: PMC8210572 DOI: 10.7150/jca.58887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/19/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Tumor stroma percentage (TSP), as an independent, low-cost prognostic factor, could complement current pathology and act as a more feasible risk factor for prognosis. However, TSP hadn't been applied into TNM staging. Here, the objective of our study was to investigate the prognostic significance of TSP in a robust rapid multi-dynamic approach with the application of MATLAB and threshold Algorithm for Gray Image analysis. Methods: Using a retrospective collection of 1539 CRC patients comprising three independent cohorts; one SGH cohort (N=996) and two validation cohorts (N =106, N= 437) from 2 institutions. We investigated 996 CRC of no special type. According to our established thresholds, 357 cases (35.84%) were classified as TSP-high and 639 cases (64.16%) as TSP-low. We determined the gray image area as the stromal part of the WSI and calculated the stroma percentage with our proposed method on MATLAB software. Results: In both TSP-cad(50%) and TSP-cad(median), multivariate analysis showed the TSP-cad was an independent prognostic factor for the vessel invasion and tumor location. For OS, TSP-manual HR=1.512 (95% CI 1.045-2.187); TSP-cad HR=1.443 (95% CI 0.993-2.097) and TSP-cad(median) HR=1.632 (95% CI 1.105-2.410). Fortunately, TSP-manual and TSP-cad were also found independent prognostic factor in all the cohorts. It was found that TSP-cad had slightly higher HR and wider CI than TSP-manual. Conclusions: Our research showed that TSP was an independent prognostic factor in CRC. Moreover, threshold algorithm for the quantitation of TSP could be established. In conclusion, with this Rapid multi-dynamic threshold Algorithm for Gray Image counting of TSP, which showed a higher accuracy than manual evaluation by pathologists and could be a practical method for CRC to guide clinical decision making.
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Affiliation(s)
- Tengfei Li
- Department of Gastrointestinal Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 201600, China.,Graduate School of Bengbu Medical College, Bengbu 233000, China
| | - Zekuan Yu
- Academy for Engineering and Technology, Fudan University, Shanghai 200433, China.,Key Laboratory of Industrial Dust Prevention and Control & Occupational Health and Safety, Ministry of Education
| | - Yan Yang
- Graduate School of Bengbu Medical College, Bengbu 233000, China
| | - Zhongmao Fu
- Department of Gastrointestinal Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 201600, China
| | - Ziang Chen
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Qi Li
- Department of Medical Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200021, China
| | - Kundong Zhang
- Department of Gastrointestinal Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 201600, China
| | - Zai Luo
- Department of Gastrointestinal Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 201600, China
| | - Zhengjun Qiu
- Department of Gastrointestinal Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 201600, China
| | - Chen Huang
- Department of Gastrointestinal Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 201600, China
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Schiele S, Arndt TT, Martin B, Miller S, Bauer S, Banner BM, Brendel EM, Schenkirsch G, Anthuber M, Huss R, Märkl B, Müller G. Deep Learning Prediction of Metastasis in Locally Advanced Colon Cancer Using Binary Histologic Tumor Images. Cancers (Basel) 2021; 13:2074. [PMID: 33922988 PMCID: PMC8123276 DOI: 10.3390/cancers13092074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/15/2021] [Accepted: 04/21/2021] [Indexed: 12/12/2022] Open
Abstract
In this study, we developed the Binary ImaGe Colon Metastasis classifier (BIg-CoMet), a semi-guided approach for the stratification of colon cancer patients into two risk groups for the occurrence of distant metastasis, using an InceptionResNetV2-based deep learning model trained on binary images. We enrolled 291 colon cancer patients with pT3 and pT4 adenocarcinomas and converted one cytokeratin-stained representative tumor section per case into a binary image. Image augmentation and dropout layers were incorporated to avoid overfitting. In a validation collective (n = 128), BIg-CoMet was able to discriminate well between patients with and without metastasis (AUC: 0.842, 95% CI: 0.774-0.911). Further, the Kaplan-Meier curves of the metastasis-free survival showed a highly significant worse clinical course for the high-risk group (log-rank test: p < 0.001), and we demonstrated superiority over other established risk factors. A multivariable Cox regression analysis adjusted for confounders supported the use of risk groups as a prognostic factor for the occurrence of metastasis (hazard ratio (HR): 5.4, 95% CI: 2.5-11.7, p < 0.001). BIg-CoMet achieved good performance for both UICC subgroups, especially for UICC III (n = 53), with a positive predictive value of 80%. Our study demonstrates the ability to stratify colon cancer patients via a semi-guided process on images that primarily reflect tumor architecture.
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Affiliation(s)
- Stefan Schiele
- Institute of Mathematics, Augsburg University, 86159 Augsburg, Germany; (T.T.A.); (G.M.)
| | - Tim Tobias Arndt
- Institute of Mathematics, Augsburg University, 86159 Augsburg, Germany; (T.T.A.); (G.M.)
- General Pathology and Molecular Diagnostics, Medical Faculty, 86156 Augsburg, Germany; (B.M.); (S.M.); (S.B.); (B.M.B.); (E.-M.B.); (R.H.); (B.M.)
| | - Benedikt Martin
- General Pathology and Molecular Diagnostics, Medical Faculty, 86156 Augsburg, Germany; (B.M.); (S.M.); (S.B.); (B.M.B.); (E.-M.B.); (R.H.); (B.M.)
| | - Silvia Miller
- General Pathology and Molecular Diagnostics, Medical Faculty, 86156 Augsburg, Germany; (B.M.); (S.M.); (S.B.); (B.M.B.); (E.-M.B.); (R.H.); (B.M.)
| | - Svenja Bauer
- General Pathology and Molecular Diagnostics, Medical Faculty, 86156 Augsburg, Germany; (B.M.); (S.M.); (S.B.); (B.M.B.); (E.-M.B.); (R.H.); (B.M.)
| | - Bettina Monika Banner
- General Pathology and Molecular Diagnostics, Medical Faculty, 86156 Augsburg, Germany; (B.M.); (S.M.); (S.B.); (B.M.B.); (E.-M.B.); (R.H.); (B.M.)
| | - Eva-Maria Brendel
- General Pathology and Molecular Diagnostics, Medical Faculty, 86156 Augsburg, Germany; (B.M.); (S.M.); (S.B.); (B.M.B.); (E.-M.B.); (R.H.); (B.M.)
| | - Gerhard Schenkirsch
- Tumor Data Management, University Hospital of Augsburg, 86156 Augsburg, Germany;
| | - Matthias Anthuber
- General, Visceral, and Transplantation Surgery, University Hospital of Augsburg, 86156 Augsburg, Germany;
| | - Ralf Huss
- General Pathology and Molecular Diagnostics, Medical Faculty, 86156 Augsburg, Germany; (B.M.); (S.M.); (S.B.); (B.M.B.); (E.-M.B.); (R.H.); (B.M.)
| | - Bruno Märkl
- General Pathology and Molecular Diagnostics, Medical Faculty, 86156 Augsburg, Germany; (B.M.); (S.M.); (S.B.); (B.M.B.); (E.-M.B.); (R.H.); (B.M.)
| | - Gernot Müller
- Institute of Mathematics, Augsburg University, 86159 Augsburg, Germany; (T.T.A.); (G.M.)
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