• Hao Dang, Gabi W van Pelt, Krijn Jc Haasnoot, Yara Backes, Sjoerd G Elias, Tom Cj Seerden, Matthijs P Schwartz, Bernhard Wm Spanier, Wouter H de Vos Tot Nederveen Cappel, Jeroen D van Bergeijk, Koen Kessels, Joost Mj Geesing, John N Groen, Frank Ter Borg, Frank Hj Wolfhagen, Cornelis A Seldenrijk, Mihaela G Raicu, Anya N Milne, Anja Ug van Lent, Lodewijk Aa Brosens, Offerhaus G Johan A GJA Department of Pathology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands., Peter D Siersema, Rob Aem Tollenaar, James Ch Hardwick, Lukas Jac Hawinkels, Leon Mg Moons, Miangela M Lacle, Wilma E Mesker, Jurjen J Boonstra, and Dutch T1 CRC Working Group.
• Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands.
• United European Gastroenterol J. 2020 Nov 19: 2050640620975324.

BackgroundCurrent risk stratification models for early invasive (T1) colorectal cancer are not able to discriminate accurately between prognostic favourable and unfavourable tumours, resulting in over-treatment of a large (>80%) proportion of T1 colorectal cancer patients. The tumour-stroma ratio (TSR), which is a measure for the relative amount of desmoplastic tumour stroma, is reported to be a strong independent prognostic factor in advanced-stage colorectal cancer, with a high stromal content being associated with worse prognosis and survival. We aimed to investigate whether the TSR predicts clinical outcome in patients with non-pedunculated T1 colorectal cancer.MethodsHematoxylin and eosin (H&E)-stained tumour tissue slides from a retrospective multi-centre case cohort of patients with non-pedunculated surgically treated T1 colorectal cancer were assessed for TSR by two independent observers who were blinded for clinical outcomes. The primary end point was adverse outcome, which was defined as the presence of lymph node metastasis in the resection specimen or colorectal cancer recurrence during follow-up.ResultsAll 261 patients in the case cohort had H&E slides available for TSR scoring. Of these, 183 were scored as stroma-low, and 78 were scored as stroma-high. There was moderate inter-observer agreement (κ = 0.42). In total, 41 patients had lymph node metastasis, 17 patients had recurrent cancer and five had both. Stroma-high tumours were not associated with an increased risk for an adverse outcome (adjusted hazard ratio = 0.66, 95% confidence interval 0.37-1.18; p = 0.163).ConclusionsOur study emphasises that existing prognosticators may not be simply extrapolated to T1 colorectal cancers, even though their prognostic value has been widely validated in more advanced-stage tumours.

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