Tumor–stroma ratio is an independent predictor for survival in early cervical carcinoma

• It is the first investigation on the prognostic role of tumor–stroma ratio (TSR) in cervical cancer.
• TSR was confirmed as an independent prognostic factor for early cervical cancer.
• Possible application of TSR in clinical and pathologic practice for better classification of patients with early cervical cancer in the future.

ObjectiveTumor–stroma ratio (TSR) has recently been identified as an independent prognostic parameter for several solid tumors. The aim of the present study was to evaluate the prognostic role of TSR in early cervical cancer.MethodsA cohort of 184 patients who had surgery for early stage cervical cancer (FIGO [International Federation of Gynecology and Obstetrics] stages IA2–IIA) were enrolled in this study. TSR was estimated on hematoxylin–eosin-stained tissue sections from the most invasive part of the primary tumor. Patients with less than 50% stroma were classified as stroma-poor and patients with ≥ 50% stroma were classified as stroma-rich. The relationship between TSR and survival time was statistically analyzed.ResultsThe disease-free survival and overall survival rates were 88.44% and 92.52%, respectively, in the stroma-poor group, and 62.16% and 70.27%, respectively, in the stroma-rich group. Both the disease-free and overall survival rates in the stroma-poor group were significantly better than those in the stroma-rich group (p = 0.001). In a multivariate analysis, TSR was further confirmed as a significant prognostic factor for disease-free survival (hazard ratio 3.125; p = 0.005) and overall survival (hazard ratio 3.464; p = 0.003), independent of tumor size, FIGO stage and lymph node metastasis.ConclusionOur study identified that TSR was an independent prognostic factor of early cervical cancer. Patients with stroma-rich tumors had worse prognosis and higher risk of relapse compared with those with stroma-poor tumors. Considering its simplicity and availability for conventional clinical pathology, TSR may serve as a new prognostic histological characteristic in early cervical cancer.