Prognostic Significance of Tumor-Stroma Ratio in Hepatocellular and Gallbladder Carcinomas: A Systematic Review and Meta-Analysis

Authors

  • Sana Ahuja Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
  • Marzieh Fattahi-Darghlou Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
  • Sufian Zaheer Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
  • Alireza Mosavi Jarrahi Department of Social Medicine, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • Seyed Saeed Hashemi Nazari Department of Epidemiology, School of Public Health and Safety, Prevention of Cardiovascular Disease Research Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Iran.
  • Amina Mohammed Al Marzouqi Vice Chancellor University of Sharjah, College of Health Sciences, University of Sharjah, Sharjah, UAE.
  • Syed Aziz Rahman College of Health Sciences, University of Sharjah, Sharjah, UAE.
  • Nabeel Al-Yateem
  • Zalikha Khamis Darwish Al-Marzouqi Oman College of Health Sciences, North Batinah Branch, Oman.
  • Maria Pramila D'Costa Oman College of Health Sciences North Batinah Branch Suhar, Sultanate of Oman.

Keywords:

Tumor stroma ratio, gall bladder cancer, hepatocellular carcinoma, prognostic, tumor microenvironment

Abstract

Background: The tumor microenvironment plays a crucial role in cancer progression, with the tumor-stroma ratio (TSR) emerging as a prognostic marker in solid tumors. A high TSR, indicating a greater proportion of tumor cells relative to stromal tissue, has been associated with improved survival. However, its prognostic value in hepatocellular carcinoma (HCC) and gallbladder carcinoma (GBC) remains unclear. This meta-analysis aims to assess the prognostic significance of TSR in these cancers.

Materials and methods: A systematic search of PubMed, Scopus, and Web of Science was conducted following PRISMA guidelines. Eligible cohort studies assessing TSR in HCC and GBC were included. Hazard ratios (HRs) for overall survival were pooled using a random-effects model. Heterogeneity was assessed using the I² statistic. The risk of bias was evaluated using the Newcastle-Ottawa Scale.

Results: Four retrospective cohort studies with 542 patients were included. A high TSR was significantly associated with improved survival in HCC (HR: 2.566, 95% CI: 1.028–4.104) but showed a weaker, non-significant association in GBC (HR: 1.568, 95% CI: 0.327–2.809). No publication bias was detected (Egger’s test, p=0.552).

Conclusion: This meta-analysis highlights TSR as a potential prognostic marker in HCC, where a high TSR is associated with improved survival. In GBC, the prognostic significance of TSR remains uncertain, possibly due to tumor heterogeneity and advanced-stage diagnoses. Given its prognostic value, TSR could be integrated into routine histopathological assessments, particularly in HCC, to enhance risk stratification and guide clinical decision-making.

 

 

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Published

2025-09-19

Issue

Vol. 10 No. 3 (2025)

Section

Systematic Review and Meta-analysis:

License

 West Asia Organization for Cabcer Prevention retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License 4 (This permits anyone to copy, distribute, transmit and adapt the published work, provided the original work and source are appropriately cited).