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Poster display session

996 - Improving treatment decisions in colon cancer. The tumor-stroma ratio (TSR) additional to the TNM classification.


09 Sep 2017


Poster display session


Staging Procedures (not Imaging);  Colon and Rectal Cancer


Wilma Mesker


Annals of Oncology (2017) 28 (suppl_5): v158-v208. 10.1093/annonc/mdx393


W. Mesker1, G. van Pelt1, A. Huijbers1, J. van der Laak2, E. Dequeker3, J. Fléjou4, R. Al Dieri5, D. Kerr6, J. Van Krieken2, R. Tollenaar1

Author affiliations

  • 1 Surgery, Leiden University Medical Center, 2300 RC - Leiden/NL
  • 2 Pathology, Radboud UMC, Nijmegen/NL
  • 3 Medische Diagnostiek, KUL-UZ, 3000 - Leuven/BE
  • 4 Pathology, Hôpital Saint Antoine, Paris/FR
  • 5 .., European Society of Pathology, Brussels/BE
  • 6 Nuffield Division Of Clinical And Laboratory Sciences, University of Oxford, OX3 7LE - Oxford/GB


Abstract 996


The tumor-micro-environment is an important determinant of tumor behaviour. We developed a new, easy to apply, practice changing method to select colon cancer patients for adjuvant therapy: the tumor-stroma ratio (TSR). This parameter is independently validated. The current proposal aims to prepare implementation of the method by training international pathologists and prospective validation of the parameter in an international setting.


1. A reproducibility study on TSR scoring in H&E stained tumor tissues will be conducted among international pathologists. An e-learning module will be developed with a quality assessment program in the framework of the European Society of Pathology EQA program. 2. Automation of the TSR using whole slide imaging and state-of-the-art pattern recognition techniques. 3. A prospective clinical trial will be performed that evaluates the introduction of the TSR in clinical practice.


A high amount of stroma within the primary tumor results in worse patient outcome. The TSR can be determined at routine pathology diagnostics and has an excellent inter-observer agreement with K > 0.80. The TSR has been validated by independent international groups. Moreover it has been validated for breast, oesophageal, cervical, lung and gastric cancer. For colon cancer several cohort studies resulted in significant differences in survival time between stroma-high and stroma-low patients (p 


Standardization and prospective validation of TSR will result in inclusion of the parameter in the TNM classification leading to more accurate decision making for adjuvant chemotherapy.

Clinical trial identification

Legal entity responsible for the study

Leiden University Medical Center


Dutch Cancer Society (KWF)


All authors have declared no conflicts of interest.

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