{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T14:31:35Z","timestamp":1791469895390,"version":"4.3.4"},"reference-count":19,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2018,10,16]],"date-time":"2018-10-16T00:00:00Z","timestamp":1539648000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Keukenhof voor de Vroege Opsporing van Kanker, Lisse"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl Journal of Cancer"],"published-print":{"date-parts":[[2018,12,15]]},"abstract":"<jats:p>The tumor\u2013stroma ratio (TSR) has previously been found to be a strong prognostic parameter in primary breast cancer tumors. Since the presence of tumor cells in lymph nodes is important for clinical decision making, the influence of TSR in the primary breast tumor combined with the TSR in tumor\u2010positive lymph nodes on prognosis was evaluated. Women with invasive breast cancer without distant metastasis who underwent an axillary lymph node dissection between 1985 and 1994 at the Leiden University Medical Center were retrospectively analyzed. TSR assessment was performed on hematoxylin and eosin stained tissue slides. In total, 87 (45.5%) primary tumors were scored as stroma\u2010low and 104 (54.5%) as stroma\u2010high. Patients with a high stromal percentage in the primary tumors had a statistically significant worse relapse free period (RFP) compared to stroma\u2010low tumors (HR 1.97, 95% CI 1.37\u20132.82, <jats:italic>p<\/jats:italic> &lt; 0.001). A total number of 915 lymph nodes were assessed for TSR. In 101 (52.9%) patients, heterogeneity was observed between stroma percentage category in primary tumor and lymph nodes. The combination of TSR of the primary tumor combined with TSR of tumor\u2010positive lymph nodes strengthened each other as independent prognostic parameter for RFP (<jats:italic>p<\/jats:italic> = 0.019). Patients with primary tumor stroma\u2010low\/lymph nodes stroma\u2010low tumors showed strongly improved RFP rates compared to patients with primary tumor stroma\u2010high\/lymph node stroma\u2010high tumors with 10\u2010year percentages of 58 <jats:italic>versus<\/jats:italic> 8%, respectively. Assessing the TSR on tumor\u2010positive lymph nodes can provide additional prognostic information. Stromal activation strongly differs between primary tumors and lymph node metastasis.<\/jats:p>","DOI":"10.1002\/ijc.31658","type":"journal-article","created":{"date-parts":[[2018,7,6]],"date-time":"2018-07-06T09:07:20Z","timestamp":1530868040000},"page":"3194-3200","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["The prognostic value of tumor\u2013stroma ratio in tumor\u2010positive axillary lymph nodes of breast cancer patients"],"prefix":"10.1002","volume":"143","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9553-4691","authenticated-orcid":false,"given":"Kiki M.H.","family":"Vangangelt","sequence":"first","affiliation":[{"name":"Department of Surgery Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisanne S.A.","family":"Tollenaar","sequence":"additional","affiliation":[{"name":"Department of Surgery Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabi W.","family":"van Pelt","sequence":"additional","affiliation":[{"name":"Department of Surgery Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther M.","family":"de Kruijf","sequence":"additional","affiliation":[{"name":"Department of Surgery Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim J.A.","family":"Dekker","sequence":"additional","affiliation":[{"name":"Department of Surgery Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J.K.","family":"Kuppen","sequence":"additional","affiliation":[{"name":"Department of Surgery Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rob 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