University of Oulu

Almangush, A., Alabi, R.O., Troiano, G. et al. Clinical significance of tumor-stroma ratio in head and neck cancer: a systematic review and meta-analysis. BMC Cancer 21, 480 (2021).

Clinical significance of tumor-stroma ratio in head and neck cancer : a systematic review and meta-analysis

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Author: Almangush, Alhadi1,2,3,4,5; Alabi, Rasheed Omobolaji6; Troiano, Giuseppe7;
Organizations: 1Department of Pathology, University of Helsinki, Haartmaninkatu 3, P.O. Box 21, Helsinki, Finland
2Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
3Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
4Institute of Biomedicine, Pathology, University of Turku, Turku, Finland
5Faculty of Dentistry, Misurata University, Misurata, Libya
6Department of Industrial Digitalization, School of Technology and Innovations, University of Vaasa, Vaasa, Finland
7Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
8Department of Oral Diagnosis, School of Dentistry, University of Campinas, Piracicaba, São Paulo, Brazil
9Department of Pathology, University of Helsinki, Helsinki, Finland
10Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
11Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
12Department of Public Health, University of Helsinki, Helsinki, Finland
13Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland
14Department of Otorhinolaryngology – Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
15Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
16Institute of Biomedicine, Pathology, University of Turku and Turku University Hospital, Turku, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.1 MB)
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Language: English
Published: Springer Nature, 2021
Publish Date: 2021-06-23


Background: The clinical significance of tumor-stroma ratio (TSR) has been examined in many tumors. Here we systematically reviewed all studies that evaluated TSR in head and neck cancer.

Methods: Four databases (Scopus, Medline, PubMed and Web of Science) were searched using the term tumo(u)r-stroma ratio. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) were followed.

Results: TSR was studied in nine studies of different subsites (including cohorts of nasopharyngeal, oral, laryngeal and pharyngeal carcinomas). In all studies, TSR was evaluated using hematoxylin and eosin staining. Classifying tumors based on TSR seems to allow for identification of high-risk cases. In oral cancer, specifically, our meta-analysis showed that TSR is significantly associated with both cancer-related mortality (HR 2.10, 95%CI 1.56–2.84) and disease-free survival (HR 1.84, 95%CI 1.38–2.46).

Conclusions: The assessment of TSR has a promising prognostic value and can be implemented with minimum efforts in routine head and neck pathology.

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Series: BMC cancer
ISSN: 1471-2407
ISSN-E: 1471-2407
ISSN-L: 1471-2407
Volume: 20
Issue: 1
Article number: 480
DOI: 10.1186/s12885-021-08222-8
Type of Publication: A2 Review article in a scientific journal
Field of Science: 3122 Cancers
Funding: This study is funded by Turku University Hospital Fund, Helsinki University Hospital Research Fund, Finnish Cancer Society, Finska Läkaresällskapet, and the Maritza and Reino Salonen Foundation.
Copyright information: The Author(s). 2021. Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.