Uniform Noting for International application of the Tumour-stroma ratio
as Easy Diagnostic tool

There is increasing evidence that the tumour stroma plays an important role in the biological behavior of tumours, their growth, ability to metastasize, but also their response or resistance to anti-cancer drugs [1-4]. Tumours, that are rich in stroma behave in a more aggressive way compared to tumours that have little stroma.

The TSR parameter is based on the amount of stroma or fibrosis within the primary tumour and can be determined during routine pathology diagnostic assessment. Using the TSR, stage II/III stroma-high (high-risk) patients will be adequately registered for treatment with chemotherapy whereas for the (elderly) patient with stage III and stroma-low it can be further discussed if adjuvant therapy benefits. New guidelines for patient management will be developed and will have consequences for clinical patient management leading to a reduction in costs due to a better selection for adjuvant chemotherapy.

The study goal is to add the TSR to current routine pathology diagnosis next to the TNM classification.

baseline / registration

surgery + pathology

3 year follow up for recurrence and survival

Since the TSR is determined on routine resection tissue used for conventional pathological clinical decision making, there is no additional intervention for the patient.