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It synthesizes 51 eligible studies reporting overall survival (OS) and/or disease-free survival (DFS) stratified by high TSR criteria. High TSR frequency among overall malignancies is 0.605, with substantial variation by cancer type. High TSR generally associates with improved OS and DFS, except in endometrial cancers where it predicts worse outcomes. TSR is proposed as a routine, microscopy-based prognostic biomarker.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/significance-of-tumor-stroma-ratio-tsr-in-predicting-outcomes-of-malignant-tumors/381387/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/significance-of-tumor-stroma-ratio-tsr-in-predicting-outcomes-of-malignant-tumors/381387.png","ImageObject",300,407,{"name":92,"@type":93},"Aria Callaghan","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-31","2026-09-24",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What was the purpose of this study regarding TSR?","Question",{"text":112,"@type":113},"To clarify how tumor–stroma ratio (TSR) is distributed and how it relates to prognosis across various malignant tumors using a meta-analysis.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How were eligible studies selected for survival outcomes?",{"text":117,"@type":113},"The meta-analysis included 51 studies that provided information for overall survival (OS) and/or disease-free survival (DFS) according to TSR criteria.",{"name":119,"@type":110,"acceptedAnswer":120},"What overall prognostic relationship was found for high TSR?",{"text":121,"@type":113},"In overall cases, patients with high TSR showed better OS and DFS than those with low TSR, based on pooled hazard ratios.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},381387,1790584334,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145},962084926284,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","medicina  \nArticle  \nSignificance of Tumor–Stroma Ratio (TSR) in Predicting Outcomes of Malignant Tumors  \nJung-Soo Pyo 1,†, Nae Yu Kim 2,†, Kyueng-Whan Min 1 and Dong-Wook Kang 3,4, *  \nCitation: Pyo, J.-S.; Kim, N.Y.; Min, K.-W.; Kang, D.-W. Significance of Tumor–Stroma Ratio (TSR) in Predicting Outcomes of Malignant Tumors. Medicina 2023, 59, 1258 . [https://doi.org/10.3390/](https://doi.org/10.3390/)[ ](https://doi.org/10.3390/)medicina59071258  \nAcademic Editor: Sorin Tiberiu Alexandrescu  \nReceived: 4 May 2023  \nRevised: 17 June 2023  \nAccepted: 27 June 2023  \nPublished: 6 July 2023  \nCopyright: © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://](https://)[ ](https://)[creativecommons.org/licenses/by/](creativecommons.org/licenses/by/)[ ](creativecommons.org/licenses/by/)[4.0/](4.0/)) .  \n1 Department of Pathology, Uijeongbu Eulji University Hospital, Eulji University School of Medicine, Uijeongbu-si 11759, Republic of Korea; [jspyo@eulji.ac.kr](jspyo@eulji.ac.kr) (J.-S.P.); [kyueng@eulji.ac.kr](kyueng@eulji.ac.kr) (K.-W.M.)  \n2 Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu-si 11759, Republic of Korea; [naeyu46@eulji.ac.kr](naeyu46@eulji.ac.kr)  \n3 Department of Pathology, Chungnam National University Sejong Hospital, 20 Bodeum 7-ro, Sejong 30099, Republic of Korea  \n4 Department of Pathology, Chungnam National University School of Medicine, 266 Munhwa Street, Daejeon 35015, Republic of Korea  \n* Correspondence: [astro966@cnuh.co.kr](astro966@cnuh.co.kr); Tel.: +82-10-8561-9895 † These authors contributed equally to this work.  \nAbstract: Background and Objectives: The present study aimed to elucidate the distribution and the prognostic implications of tumor–stroma ratio (TSR) in various malignant tumors through a metaanalysis. Materials and Methods: This meta-analysis included 51 eligible studies with information for overall survival (OS) or disease-free survival (DFS), according to TSR. In addition, subgroup analysis was performed based on criteria for high TSR. Results: The estimated rate of high TSR was 0.605 (95% confidence interval (CI) 0.565–0.644) in overall malignant tumors. The rates of high TSR ranged from 0.276 to 0.865 . The highest rate of high TSR was found in endometrial cancer (0.865, 95% CI 0.827–0.895) . The estimated high TSR rates of colorectal, esophageal, and stomach cancers were 0.622, 0.529, and 0.448, respectively. In overall cases, patients with high TSR had better OS and DFS than those with low TSR (hazard ratio (HR) 0.631, 95% CI 0.542–0.734, and HR 0.564, 95% CI 0.0.476–0.669, respectively) . Significant correlations with OS were found in the breast, cervical, colorectal, esophagus, head and neck, ovary, stomach, and urinary tract cancers. In addition, there were significant correlations of DFS in breast, cervical, colorectal, esophageal, larynx, lung, and stomach cancers. In endometrial cancers, high TSR was significantly correlated with worse OS and DFS. Conclusions: The rate of high TSR was different in various malignant tumors. TSR can be useful for predicting prognosis through a routine microscopic examination of malignant tumors.  \nKeywords: tumor–stroma ratio; malignant tumor; prognosis; meta-analysis  \n1. Introduction  \nPathological examination is performed through the interpretation of glass slides with hematoxylin and eosin (H&E) staining. In the pathological assessment of malignant tumors, the primary tumor, regional lymph node, and distant metastasis are evaluated according to the American Joint Committee on Cancer (AJCC) Cancer Staging Manual [1] . Tumor differentiation, lymphovascular invasion, perineural invasion, and resection margin involvement are evaluated in daily practice. Useful parameters for predicting the patient's prognosis should have easy identification, hi","cbCaiqGsOTzy87od","https://ap.wps.com/l/cbCaiqGsOTzy87od","pdf",664721,13,"English","# Abstract\n# Introduction\n## Pathological assessment and rationale for TSR\n## Biological context and prior evidence","[{\"question\":\"What was the purpose of this study regarding TSR?\",\"answer\":\"To clarify how tumor–stroma ratio (TSR) is distributed and how it relates to prognosis across various malignant tumors using a meta-analysis.\"},{\"question\":\"How were eligible studies selected for survival outcomes?\",\"answer\":\"The meta-analysis included 51 studies that provided information for overall survival (OS) and/or disease-free survival (DFS) according to TSR criteria.\"},{\"question\":\"What overall prognostic relationship was found for high TSR?\",\"answer\":\"In overall cases, patients with high TSR showed better OS and DFS than those with low TSR, based on pooled hazard ratios.\"}]","Significance of Tumor–Stroma Ratio (TSR) in Predicting Outcomes of Malignant Tumors | PDF",1790245093,33]