Tumor-Stroma Ratio is a Critical Indicator of Peritoneal Metastasis in Gastric Cancer

Overview

Journal Clin Exp Gastroenterol

Publisher Dove Medical Press

Date 2025 Jan 27

PMID 39867580

Authors

Lin Zhong

Hongyun Huang

Dong Hou

Shihai Zhou

Yu Lin

Yue Yu

Jinhao Yu

Fanghai Han

Lang Xie

Affiliations

Soon will be listed here.

Abstract

Objective: This study aims to investigate the correlation between the tumor-stroma ratio (TSR) and peritoneal metastasis (PM) in gastric cancer (GC) and constructs a diagnostic model based on preoperative examination data.

Methods: To determine the feasibility of obtaining TSR in GC patients through preoperative examinations, the consistency of TSR between endoscopic biopsy tissues and postoperative histopathological tissues was evaluated. Additionally, the correlation between TSR and PM in GC was analyzed using Gene Expression Omnibus (GEO) datasets. To validate TSR's clinical potential in diagnosing PM, 640 GC patients from two medical centers were enrolled. A training cohort of 330 patients evaluated TSR and synchronous PM correlation, and a validation cohort of 310 patients was used. An additional cohort of 510 patients was established to investigate TSR and metachronous PM. A diagnostic model based on preoperative data was developed and a nomogram constructed.

Results: The TSR shows good consistency between endoscopic biopsy tissues and postoperative histopathological tissues. A significant correlation between TSR and PM was observed. The TSR-based model, combined with CA125, CA724 and Borrmann type, exhibited strong diagnostic effectiveness and considerable predictive efficacy, with an Area Under the Curve (AUC) of 0.85 in the training cohort, 0.73 in the external validation cohort, and 0.72 in the metachronous PM cohort.

Conclusion: The TSR emerges as a crucial marker for PM in GC, with the developed model, based on TSR and preoperative examination data, demonstrating substantial diagnostic and predictive capabilities.

References

Chen Y, Cai G, Jiang J, He C, Chen Y, Ding Y . Proteomic profiling of gastric cancer with peritoneal metastasis identifies a protein signature associated with immune microenvironment and patient outcome. Gastric Cancer. 2023; 26(4):504-516. PMC: 10284991. DOI: 10.1007/s10120-023-01379-0. View

Fujimura T, Kinami S, Ninomiya I, Kitagawa H, Fushida S, Nishimura G . Diagnostic laparoscopy, serum CA125, and peritoneal metastasis in gastric cancer. Endoscopy. 2002; 34(7):569-74. DOI: 10.1055/s-2002-33228. View

Gong X, Hou D, Zhou S, Tan J, Zhong G, Yang B . FMO family may serve as novel marker and potential therapeutic target for the peritoneal metastasis in gastric cancer. Front Oncol. 2023; 13:1144775. PMC: 10234505. DOI: 10.3389/fonc.2023.1144775. View

Zhang C, Li D, Yu R, Li C, Song Y, Chen X . Immune Landscape of Gastric Carcinoma Tumor Microenvironment Identifies a Peritoneal Relapse Relevant Immune Signature. Front Immunol. 2021; 12:651033. PMC: 8155484. DOI: 10.3389/fimmu.2021.651033. View

Gotze T, Piso P, Lorenzen S, Bankstahl U, Pauligk C, ElShafei M . Preventive HIPEC in combination with perioperative FLOT versus FLOT alone for resectable diffuse type gastric and gastroesophageal junction type II/III adenocarcinoma - the phase III "PREVENT"- (FLOT9) trial of the AIO /CAOGI /ACO. BMC Cancer. 2021; 21(1):1158. PMC: 8555172. DOI: 10.1186/s12885-021-08872-8. View

Koemans W, Lurvink R, Grootscholten C, Verhoeven R, de Hingh I, van Sandick J . Synchronous peritoneal metastases of gastric cancer origin: incidence, treatment and survival of a nationwide Dutch cohort. Gastric Cancer. 2021; 24(4):800-809. DOI: 10.1007/s10120-021-01160-1. View

Yonemura Y, Elnemr A, Endou Y, Ishibashi H, Mizumoto A, Miura M . Effects of neoadjuvant intraperitoneal/systemic chemotherapy (bidirectional chemotherapy) for the treatment of patients with peritoneal metastasis from gastric cancer. Int J Surg Oncol. 2012; 2012:148420. PMC: 3415092. DOI: 10.1155/2012/148420. View

Peng C, Liu J, Yang G, Li Y . The tumor-stromal ratio as a strong prognosticator for advanced gastric cancer patients: proposal of a new TSNM staging system. J Gastroenterol. 2017; 53(5):606-617. PMC: 5910462. DOI: 10.1007/s00535-017-1379-1. View

Chen D, Liu Z, Liu W, Fu M, Jiang W, Xu S . Predicting postoperative peritoneal metastasis in gastric cancer with serosal invasion using a collagen nomogram. Nat Commun. 2021; 12(1):179. PMC: 7794254. DOI: 10.1038/s41467-020-20429-0. View

10.

Yang X, Huang C, Suo T, Mei L, Yang G, Cheng F . Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy improves survival of patients with peritoneal carcinomatosis from gastric cancer: final results of a phase III randomized clinical trial. Ann Surg Oncol. 2011; 18(6):1575-81. PMC: 3087875. DOI: 10.1245/s10434-011-1631-5. View

11.

Bonnot P, Piessen G, Kepenekian V, Decullier E, Pocard M, Meunier B . Cytoreductive Surgery With or Without Hyperthermic Intraperitoneal Chemotherapy for Gastric Cancer With Peritoneal Metastases (CYTO-CHIP study): A Propensity Score Analysis. J Clin Oncol. 2019; 37(23):2028-2040. DOI: 10.1200/JCO.18.01688. View

12.

Montori G, Coccolini F, Ceresoli M, Catena F, Colaianni N, Poletti E . The treatment of peritoneal carcinomatosis in advanced gastric cancer: state of the art. Int J Surg Oncol. 2014; 2014:912418. PMC: 3947693. DOI: 10.1155/2014/912418. View

13.

Liu S, He J, Liu S, Ji C, Guan W, Chen L . Radiomics analysis using contrast-enhanced CT for preoperative prediction of occult peritoneal metastasis in advanced gastric cancer. Eur Radiol. 2019; 30(1):239-246. DOI: 10.1007/s00330-019-06368-5. View

14.

Foster J, Zhang C, Rehman S, Sharma P, Alexander H . The contemporary management of peritoneal metastasis: A journey from the cold past of treatment futility to a warm present and a bright future. CA Cancer J Clin. 2022; 73(1):49-71. DOI: 10.3322/caac.21749. View

15.

Huang J, Yang B, Tan J, Zhou S, Chen Z, Zhong G . Gastric cancer nodal tumour-stroma ratios influence prognosis. Br J Surg. 2020; 107(13):1713-1718. PMC: 7702113. DOI: 10.1002/bjs.12054. View

16.

Entenberg D, Oktay M, Condeelis J . Intravital imaging to study cancer progression and metastasis. Nat Rev Cancer. 2022; 23(1):25-42. PMC: 9912378. DOI: 10.1038/s41568-022-00527-5. View

17.

Sato Y, Mizusawa J, Katayama H, Nakamura K, Fukagawa T, Katai H . Diagnosis of invasion depth in resectable advanced gastric cancer for neoadjuvant chemotherapy: An exploratory analysis of Japan clinical oncology group study: JCOG1302A. Eur J Surg Oncol. 2020; 46(6):1074-1079. DOI: 10.1016/j.ejso.2020.02.038. View

18.

Ravensbergen C, Kuruc M, Polack M, Crobach S, Putter H, Gelderblom H . The Stroma Liquid Biopsy Panel Contains a Stromal-Epithelial Gene Signature Ratio That Is Associated with the Histologic Tumor-Stroma Ratio and Predicts Survival in Colon Cancer. Cancers (Basel). 2022; 14(1). PMC: 8750571. DOI: 10.3390/cancers14010163. View

19.

Yonemura Y, Prabhu A, Sako S, Ishibashi H, Mizumoto A, Takao N . Long Term Survival after Cytoreductive Surgery Combined with Perioperative Chemotherapy in Gastric Cancer Patients with Peritoneal Metastasis. Cancers (Basel). 2020; 12(1). PMC: 7016959. DOI: 10.3390/cancers12010116. View

20.

Alessandrini L, Ferrari M, Taboni S, Sbaraglia M, Franz L, Saccardo T . Tumor-stroma ratio, neoangiogenesis and prognosis in laryngeal carcinoma. A pilot study on preoperative biopsies and matched surgical specimens. Oral Oncol. 2022; 132:105982. DOI: 10.1016/j.oraloncology.2022.105982. View