# Tumor-Stroma Ratio Is an Independent Prognostic Factor for Distant Metastasis in Squamous Cell Lung Cancer Following Resection

## TL;DR

This study shows that the tumor-stroma ratio in lung cancer patients can predict the risk of distant metastasis and overall survival.

## Contribution

The study identifies tumor-stroma ratio as a novel independent prognostic factor for distant metastasis in squamous cell lung cancer.

## Key findings

- Stroma-poor tumors were associated with better survival and lower metastasis risk compared to stroma-rich tumors.
- Tumor-stroma ratio was a significant predictor of overall and metastasis-free survival in multivariable analysis.
- Stroma-rich tumors had shorter metastasis-free intervals and worse prognosis in squamous cell lung cancer patients.

## Abstract

Cancer distant metastasis is one of the main causes of cancer progression and difficulty in treatment (Rossi et al., 2020). This abstract aims to summarize the significance of tumor-stroma ratio (TSR) as a prognostic factor in the development of distant metastasis in squamous cell lung cancer (SQCLC) patients. The TSR has recently been recognized as a novel and independent prognostic parameter for a variety of solid tumor types (Lu et al., 2023). A total of 86 patients with SQCLC who had undergone surgery were included in the present study. Two independent observers visually identified TSR on hematoxylin and eosin (H&E)–stained pathological histologic sections. Patients were separated into two groups: stroma-rich, with a ratio of stroma as > 50%, and stroma-poor, with a ratio of stroma as ≤ 50%, which included a total of 36 and 50 patients, respectively. In the current study, the overall survival and no distant metastasis survival of patients in the stroma-poor group were improved compared with the stroma-rich group, and the overall risk of patients in the stroma-poor group was reduced compared with the stroma-rich group (p < 0.05). In the multivariable analyses, the TSR was recognized as an important prognostic indicator for overall survival (HR = 2.41; p < 0.001) and no distant metastasis survival (HR = 2.27; p < 0.001). The study revealed that in patients with SQCLC, stroma-rich tumors were associated with a shorter distant metastasis-free interval and poorer prognosis compared to stroma-poor tumors. These findings suggest that the TSR may serve as a novel prognostic indicator for predicting distant metastasis in SQCLC.