{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T05:11:11Z","timestamp":1777957871639,"version":"3.51.4"},"reference-count":27,"publisher":"S. Karger AG","issue":"5","license":[{"start":{"date-parts":[[2025,4,19]],"date-time":"2025-04-19T00:00:00Z","timestamp":1745020800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"},{"start":{"date-parts":[[2025,4,19]],"date-time":"2025-04-19T00:00:00Z","timestamp":1745020800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathobiology"],"abstract":"<jats:p>Introduction: The tumor microenvironment plays a crucial role in the progression and prognosis of colorectal cancer (CRC). Among its components, the tumor-stroma ratio (TSR) and cancer-associated fibroblasts (CAFs) have emerged as significant prognostic markers. However, conventional assessments of TSR and CAF density remain subjective and labor-intensive, limiting their clinical applicability. Methods: We utilized an artificial intelligence (AI)-based whole slide image analysis platform, Lunit SCOPE IO, to objectively quantify TSR and CAF density in tissue samples from 207 treatment-na\u00efve patients with stage II and III CRC. Results: Our analysis demonstrated that both TSR (log-rank p &lt; 0.0001) and CAF density (log-rank p = 0.017) were independently associated with disease-free survival (DFS). These AI-derived markers outperformed conventional prognostic factors. Furthermore, integrating TSR and CAF density with existing high-risk criteria enabled reclassification of additional patients as high risk, enhancing DFS prediction and reducing false-negative rates. Conclusion: AI-powered histopathological quantification of TSR and CAF density improves prognostic accuracy in CRC and offers a promising approach for refining risk stratification. These findings support the integration of AI-based pathology into clinical practice to enhance diagnostic precision and patient management. <\/jats:p>","DOI":"10.1159\/000546021","type":"journal-article","created":{"date-parts":[[2025,4,19]],"date-time":"2025-04-19T12:00:36Z","timestamp":1745064036000},"page":"276-287","source":"Crossref","is-referenced-by-count":7,"title":["Artificial Intelligence-Driven Quantification of Tumor-Stroma Ratio and Fibroblasts Enables Precise Classification of Stroma Quality and Quantity in Predicting Colorectal Cancer Recurrence"],"prefix":"10.1159","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4313-9032","authenticated-orcid":false,"given":"Jun Yong","family":"Kim","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3087-2479","authenticated-orcid":false,"given":"Hoein","family":"Jeong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0777-9942","authenticated-orcid":false,"given":"Aaron","family":"Valero Puche","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0854-4745","authenticated-orcid":false,"given":"Sanghoon","family":"Song","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3414-9869","authenticated-orcid":false,"given":"Soo Ick","family":"Cho","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8701-4282","authenticated-orcid":false,"given":"Minsun","family":"Jung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"127","published-online":{"date-parts":[[2025,4,19]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.3390\/medicina56010015"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1007\/s12094-021-02734-2"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1038\/nrc.2016.73"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.esmoop.2024.102988"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1038\/s43018-022-00436-4"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.2017.46"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1038\/s41698-023-00470-0"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.21.02538"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1713709"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.738080"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2020.103070"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpi.2023.100191"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15102675"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.3393\/ac.2018.09.10"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.4137\/BIC.S25247"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1007\/s00428-018-2408-z"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.3389\/fgene.2022.908957"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1186\/s12943-021-01367-x"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1007\/s13277-012-0638-2"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1038\/s43018-022-00411-z"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccr.2014.04.005"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2020.565306"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2003.028365"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-22-1031"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-023-39762-1"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1186\/s12943-023-01876-x"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-22-0296"}],"container-title":["Pathobiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/pat\/article-pdf\/doi\/10.1159\/000546021\/4367048\/000546021.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/karger.com\/article-pdf\/doi\/10.1159\/000546021","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T16:06:12Z","timestamp":1759766772000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000546021"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,19]]},"references-count":27,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,10,6]]},"published-print":{"date-parts":[[2025,10,8]]}},"URL":"https:\/\/doi.org\/10.1159\/000546021","archive":["Portico"],"relation":{"is-supplemented-by":[{"id-type":"doi","id":"10.6084\/m9.figshare.28827893","asserted-by":"subject"}]},"ISSN":["1015-2008","1423-0291"],"issn-type":[{"value":"1015-2008","type":"print"},{"value":"1423-0291","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,19]]}}}