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Tumour stroma ratio assessment using digital image analysis predicts survival in triple negative and luminal breast cancer


We aimed to determine the clinical significance of tumour stroma ratio (TSR) in luminal and triple negative breast cancer (TNBC) using digital image analysis and machine learning algorithms. Automated image analysis using QuPath software was applied to a cohort of 647 breast cancer patients (403 luminal and 244 TNBC) using digital H&E images of tissue microarrays (TMAs). Kaplan-Meier and Cox proportional hazards were used to ascertain relationships with overall survival (OS) and breast cancer specific survival (BCSS). For TNBC, low TSR (high stroma) was associated with poor prognosis for both OS (HR 1.9, CI 1.1-3.3, p = 0.021) and BCSS (HR 2.6, HR 1.3-5.4, p = 0.007) in multivariate models, independent of age, size, grade, sTILs, lymph nodal status and chemotherapy. However, for luminal tumours, low TSR (high stroma) was associated with a favourable prognosis in MVA for OS (HR 0.6, CI 0.4-0.8, p = 0.001) but not for BCSS. TSR is a prognostic factor of most significance in TNBC, but also in luminal breast cancer, and can be reliably assessed using quantitative image analysis of TMAs. Further investigation into the contribution of tumour subtype stromal phenotype may further refine these findings.

Type Journal
ISBN 2072-6694 (Print) 2072-6694 (Linking)
Authors Millar, E. K.; Browne, L. H.; Beretov, J.; Lee, K.; Lynch, J.; Swarbrick, A.; Graham, P. H.
Responsible Garvan Author Prof Alexander Swarbrick
Publisher Name Cancers
Published Date 2020-12-01
Published Volume 12
Published Pages 12
Status Always Electronic
DOI 10.3390/cancers12123749
URL link to publisher's version