Molecular Diagnostics

Association of the tumour stroma percentage in the preoperative biopsies with lymph node metastasis in colorectal cancer

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Preoperative prediction of lymph node (LN) status is integral to determining the most appropriate treatment strategy for colorectal cancer (CRC). This study aimed to develop and validate a nomogram to predict LN metastasis in CRC preoperatively.


A total of 530 patients were enrolled and divided into training and validation cohorts. The tumour stroma percentage (TSP) of the preoperative biopsies was assessed. The risk factors for LN metastasis were selected, and a nomogram was constructed subsequently. The performance of the nomogram was assessed by using the AUROC and the calibration curve, and then validated in the validation cohort.


High TSP was significantly associated with LN metastasis in both the training and validation cohorts. Computed tomography (CT)-reported T stage, CT-reported LN status, preoperative tumour differentiation, carcinoembryonic antigen, carbohydrate antigen 19-9 and TSP were independent predictors of LN metastasis in CRC. A nomogram incorporating the six predictors was constructed. The nomogram yielded good discrimination and calibration, with an AUROC of 0.846 (95% CI: 0.807−0.886) and 0.809 (95% CI: 0.745−0.872) in the training and validation cohorts, respectively.


Assessment of TSP in the preoperative biopsies provided additional information about the LN status. The nomogram was useful for tailored therapy in CRC preoperatively.

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Fig. 1: Example of TSP assessment in the preoperative biopsies of CRC.
Fig. 2: Nomogram and performance evaluation.
Fig. 3: Decision-curve analysis.


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Author information

S.L., A.L. and M.F. conceived and designed the study; M.F., D.C., F.L., M.L., Y.W. and J.C. collected and assembled the data; M.F., D.C., M.L. and A.L. were responsible for data analysis and interpretation. All authors wrote and approved the paper.

Correspondence to Aimin Li or Side Liu.

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Ethics approval and consent to participate

This study was approved by the institutional review board of Nanfang Hospital, Southern Medical University. The requirement of informed consent from the patients was waived because of the retrospective design of this study, and patients’ information was protected. All procedures performed in the study involving human participants were in accordance with the Declaration of Helsinki.

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Not applicable.

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All data sets generated and/or analysed during this study are available from the corresponding author on reasonable request.

Competing interests

The authors declare no competing interests.

Funding information

This study was funded by grants from the National Natural Science Funds of China (No. 81772964), the Special Scientific Research Fund of Public Welfare Profession of National Health and Family Planning Commission (No. 201502026) and the Guangdong Gastrointestinal Disease Research Center (No. 2017B020209003).

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Fu, M., Chen, D., Luo, F. et al. Association of the tumour stroma percentage in the preoperative biopsies with lymph node metastasis in colorectal cancer. Br J Cancer (2019) doi:10.1038/s41416-019-0671-7

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