• Niko Kemi, Maarit Eskuri, Anni Herva, Joni Leppänen, Heikki Huhta, Olli Helminen, Juha Saarnio, Tuomo J Karttunen, and Joonas H Kauppila.
• Cancer and Translational Medicine Research Unit, Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland. niko.kemi@oulu.fi.
• Br. J. Cancer. 2018 Aug 1; 119 (4): 435-439.

BackgroundTumour microenvironment, including tumour-stroma ratio (TSR), might help identifying high-risk cancer patients. However, the significance of TSR in gastric cancer is unclear, especially in the intestinal and diffuse subtypes. The aim of this study was to investigate the tumour-stroma ratio in gastric adenocarcinoma, and its intestinal and diffuse histological subtypes, in relation to prognosis.MethodsFive hundred and eighty-three gastric adenocarcinoma patients who underwent surgery in Oulu University hospital during years 1983-2016 were included in this retrospective cohort study. TSR was analysed from the slides that were originally used for diagnostic purposes. Patients were divided into stroma-poor (≤50% stroma) and stroma-rich (>50% stroma) groups and TSR was analysed in relation to 5-year mortality and overall mortality.ResultsPatients with stroma-rich tumours had worse 5-year prognosis (HR 1.80, 95% CI 1.41-2.28) compared to stroma-poor tumours. Stratified analysis showed that stroma-rich tumours had worse 5-year prognosis in both intestinal (HR 1.68, 95% CI 1.24-2.27) and diffuse histological types (HR 2.09, 95% CI 1.35-3.23) compared to stroma-poor tumours, respectively.ConclusionsHigh proportion of stroma is an independent prognostic factor in both intestinal and diffuse histological subtypes of gastric adenocarcinoma.

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