AUTHOR=Zhang Xuefeng , Ma Hongfu , Zhang Liang , Li Fenghuan 

TITLE=Predictive Role of Tumor-Stroma Ratio for Survival of Patients With Non-Small Cell Lung Cancer: A Meta-Analysis

JOURNAL=Pathology and Oncology Research

VOLUME=27

YEAR=2022

URL=https://www.por-journal.com/journals/pathology-and-oncology-research/articles/10.3389/pore.2021.1610021

DOI=10.3389/pore.2021.1610021

ISSN=1532-2807

ABSTRACT=<p><bold>Background:</bold> Role of tumor-stroma ratio (TSR) as a predictor of survival in patients with non-small cell lung cancer (NSCLC) remains not clear. A systematic review and meta-analysis was conducted to summarize current evidence for the role of TSR in NSCLC.</p><p><bold>Methods:</bold> Relevant cohort studies were retrieved via search of Medline, Embase, and Web of Science databases. The data was combined with a random-effect model by incorporating the between-study heterogeneity. Specifically, subgroup and meta-regression analyses were performed to explore the association between TSR and survival in patients with squamous cell carcinoma (SCC) or adenocarcinoma (AC).</p><p><bold>Results:</bold> Nine cohort studies with 2031 patients with NSCLC were eligible for the meta-analysis. Pooled results showed that compared to those stroma-poor tumor, patients with stroma rich NSCLC were associated with worse recurrence-free survival (RFS, hazard ratio [HR] = 1.52, 95% confidence interval [CI]: 1.07 to 2.16, <italic>p</italic> = 0.02) and overall survival (OS, HR = 1.48, 95% CI: 1.20 to 1.82, <italic>p</italic> &lt; 0.001). Subgroup analyses showed that stroma-rich tumor may be associated with a worse survival of SCC (HR = 1.89 and 1.47 for PFS and OS), but a possibly favorable survival of AC (HR = 0.28 and 0.69 for PFS and OS). Results of meta-regression analysis also showed that higher proportion of patients with SCC was correlated with higher HRs for RFS (Coefficient = 0.012, <italic>p</italic> = 0.03) and OS (Coefficient = 0.014, <italic>p</italic> = 0.02) in the included patients, while higher proportion of patients with AC was correlated with lower HRs for RFS (Coefficient = −0.012, <italic>p</italic> = 0.03) and OS (Coefficient = −0.013, <italic>p</italic> = 0.04), respectively.</p><p><bold>Conclusion:</bold> Tumor TSR could be used as a predictor of survival in patients with NSCLC. The relative proportion of patients with SCC/AC in the included NSCLC patients may be an important determinant for the association between TSR and survival in NSCLC. Stroma richness may be a predictor of poor survival in patients with lung SCC, but a predictor of better survival in patients with lung AC.</p>