• Ming-Xiang Zou, Bo-Wen Zheng, Fu-Sheng Liu, Xiao-Bin Wang, Jia-Rui Hu, Wei Huang, Zhe-Hao Dai, Qian-Shi Zhang, Fu-Bing Liu, Hua Zhong, Yi Jiang, Xiao-Ling She, Xiao-Bing Li, Guo-Hua Lv, and Jing Li.
• Department of Spine Surgery, The Second Xiangya Hospital, Central South, University, Changsha, China.
• Neurosurgery. 2019 Dec 1; 85 (6): E1095-E1110.

BackgroundCurrently, little is known about the clinical relevance of tumor-stroma ratio (TSR) in chordoma and data discussing the relationship between TSR and immune status of chordoma are lacking.ObjectiveTo characterize TSR distribution in spinal chordoma, and investigated its correlation with clinicopathologic or immunological features of patients and outcome.MethodsTSR was assessed visually on hematoxylin and eosin-stained sections from 54 tumor specimens by 2 independent pathologists. Multiplex immunofluorescence was used to quantify the expression levels of microvessel density, Ki-67, Brachyury, and tumor as well as stromal PD-L1. Tumor immunity status including the Immunoscore and densities of tumor-infiltrating lymphocytes (TILs) subtypes were obtained from our published data and reanalyzed.ResultsBland-Altman plot showed no difference between mean TSR derived from the two observers. TSR was positively associated with stromal PD-L1 expression, the Immunoscore and CD3+ as well as CD4+ TILs density, but negatively correlated with tumor microvessel density, Ki-67 index, surrounding muscle invasion by tumor and number of Foxp3+ and PD-1+ TILs. Low TSR independently predicted poor local recurrence-free survival and overall survival. Moreover, patients with low TSR and low Immunoscore chordoma phenotype were associated with the worst survival. More importantly, combined TSR and Immunoscore accurately reflected prognosis and enhanced the ability of TSR or Immunoscore alone for outcome prediction.ConclusionThese data reveal the significant impact of TSR on tumor progression and immunological response of patients. Subsequent use of agents targeting the stroma compartment may be an effective strategy to treat chordoma especially in combination with immune-based drugs.Copyright © 2019 by the Congress of Neurological Surgeons.

25 keywords...

hide…