The Prognostic Value of Tumor-Stroma Proportion in Laryngeal Squamous Cell Carcinoma

Objective: Tumor-stroma proportion of tumor has been presented as a prognostic factor in some types of adenocarcinomas, but there is no information about squamous cell carcinomas and laryngeal carcinomas. Material and Method: Five digital images of the tumor sections were obtained from 85 laryngeal carcinomas. Proportion of epithelial tumor component and stroma were measured by a software tool, allowing the pathologists to mark 205.6 mu m(2) blocks on areas as carcinomatous/stromal, by clicking at the image. Totally, 3.451 mm(2) tumor areas have been marked to 16.785 small square blocks for each case. Results: Median follow up was 48 months (range 3-194). The mean tumor-stroma proportion was 48.63+18.18. There was no difference for tumor-stroma proportion when tumor location, grade, stage and perinodal invasion were considered. Although the following results were statistically insignificant, the mean tumor-stroma proportion was the lowest (37.46 +/- 12.49) for subglottic carcinomas, and it was 52.41 +/- 37.47, 50.86+19.84 and 44.56 +/- 16.91 for supraglottic, transglottic and glottic cases. The tumor-stroma proportion was lowest in cases with perinodal invasion and the highest in cases without lymph node metastasis (44.72 +/- 20.23, 47.77 +/- 17.37, 50.05 +/- 17.34). Tumor-stroma proportion was higher in the basaloid subtype compared with the classical squamous cell carcinoma (53.76 +/- 14.70 and 48.63 +/- 18.38 respectively). The overall and disease-free survival analysis did not reveal significance for tumor-stroma proportion (p=0.08, p=0.38). Only pathological stage was an independent factor for overall survival (p=0.008). Conclusion: This is the first series investigating tumor-stroma proportion as a prognostic marker in laryngeal carcinomas proposing a new method, but the findings do not support tumor-stroma proportion as a prognostic marker.