A Histology‐Derived Score Integrating Tumor–Stroma Ratio, Tertiary Lymphoid Structures, and Tumor Budding Improves Prognostic Stratification in Colorectal Cancer
- 1Graduate School Bengbu Medical University Bengbu Anhui People's Republic of China
- 2Department of Pathology Anqing Municipal Hospital, Anqing Hospital Affiliated to China Pharmaceutical University Anqing Anhui People's Republic of China
- 3Department of General Surgery Anqing Municipal Hospital, Anqing Hospital Affiliated to China Pharmaceutical University Anqing Anhui People's Republic of China
Abstract
Objective: To evaluate a histology‐derived score (HDS) integrating tumor–stroma ratio (TSR), tertiary lymphoid structures (TLS), and tumor budding (TB) for prognostic stratification in colorectal cancer (CRC) and assess its incremental prognostic value.
Methods: A total of 559 patients with CRC were retrospectively enrolled and randomly split 7:3 into a training cohort (n = 392) and an internal validation cohort (n = 167). TSR, TLS, and TB were assessed on hematoxylin and eosin (H&E)‐stained sections to construct the HDS, with predefined low‐ (3–4), intermediate‐ (5–6), and high‐risk (7–8) groups. Independent prognostic factors were identified using multivariable Cox regression and incorporated into a nomogram. The incremental prognostic value of HDS was assessed by comparing nested models using the concordance index (C‐index), likelihood‐ratio test (LRT), net reclassification improvement (NRI), and integrated discrimination improvement (IDI).
Results: Multivariable Cox regression identified HDS (HDShigh vs. HDSlow: HR = 3.10, 95% CI: 1.75–5.47, p < 0.001), TNM stage (III vs. I: HR = 3.26, 95% CI: 1.49–7.12, p < 0.001), and lymphovascular invasion (LVI) (yes vs. no: HR = 1.70, 95% CI: 1.09–2.64, p = 0.020) as independent prognostic factors for disease‐free survival (DFS). Adding HDS to TNM + LVI increased the C‐index from 0.709 to 0.738 in the training cohort (LRT, p < 0.001; NRI = 0.454, p = 0.012; IDI = 0.050, p < 0.001) and from 0.655 to 0.669 in the internal validation cohort (LRT, p = 0.033; NRI = 0.313, p = 0.148; IDI = 0.029, p = 0.044). The nomogram showed good discrimination, calibration, and clinical utility in both cohorts.
Conclusions: HDS provided incremental prognostic information beyond TNM stage and LVI in CRC. The HDS‐based nomogram may facilitate individualized prognostic assessment, although external multicenter validation is required.
Related
- Identification of Candidate Partner Cells in Tumor–Stromal Interactions by Histology-Based Spatial Analysis for Prognostic Stratification After Neoadjuvant Chemotherapy
- Toward Precision Colorectal Cancer Screening: Integrating Clinical Risk Stratification, Molecular Biomarkers, and Artificial Intelligence
- An immunogenic cell death-related classification for prognostic stratification and immunotherapy response prediction in proficient mismatch repair/microsatellite stable colorectal cancer.
- Comparative and Histology-Aware Bioinformatic Characterization of FAM171A1 and FAM171A2 in Sarcoma: Expression, Prognostic, and Immune Associations
- Histology-Stratified Clinical and Prognostic Associations of PDCD-Related Genes in Lung Adenocarcinoma and Lung Squamous Cell Carcinoma.
BibTeX
@article{tian2026histologyderived,
title = {{A Histology‐Derived Score Integrating Tumor–Stroma Ratio, Tertiary Lymphoid Structures, and Tumor Budding Improves Prognostic Stratification in Colorectal Cancer}},
author = {Meng Tian and Jianwei Yuan and Quanquan Hu and Lanlan Xuan},
journal = {Cancer Medicine},
year = {2026},
month = nov,
doi = {10.1002/cam4.72495},
url = {https://doi.org/10.1002/cam4.72495},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - A Histology‐Derived Score Integrating Tumor–Stroma Ratio, Tertiary Lymphoid Structures, and Tumor Budding Improves Prognostic Stratification in Colorectal Cancer
AU - Meng Tian
AU - Jianwei Yuan
AU - Quanquan Hu
AU - Lanlan Xuan
PY - 2026
DA - 2026/11/05
JO - Cancer Medicine
DO - 10.1002/cam4.72495
UR - https://doi.org/10.1002/cam4.72495
AB - Objective: To evaluate a histology‐derived score (HDS) integrating tumor–stroma ratio (TSR), tertiary lymphoid structures (TLS), and tumor budding (TB) for prognostic stratification in colorectal cancer (CRC) and assess its incremental prognostic value. Methods: A total of 559 patients with CRC were retrospectively enrolled and randomly split 7:3 into a training cohort (n = 392) and an internal validation cohort (n = 167). TSR, TLS, and TB were assessed on hematoxylin and eosin (H&E)‐stained sections to construct the HDS, with predefined low‐ (3–4), intermediate‐ (5–6), and high‐risk (7–8) groups. Independent prognostic factors were identified using multivariable Cox regression and incorporated into a nomogram. The incremental prognostic value of HDS was assessed by comparing nested models using the concordance index (C‐index), likelihood‐ratio test (LRT), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Results: Multivariable Cox regression identified HDS (HDShigh vs. HDSlow: HR = 3.10, 95% CI: 1.75–5.47, p < 0.001), TNM stage (III vs. I: HR = 3.26, 95% CI: 1.49–7.12, p < 0.001), and lymphovascular invasion (LVI) (yes vs. no: HR = 1.70, 95% CI: 1.09–2.64, p = 0.020) as independent prognostic factors for disease‐free survival (DFS). Adding HDS to TNM + LVI increased the C‐index from 0.709 to 0.738 in the training cohort (LRT, p < 0.001; NRI = 0.454, p = 0.012; IDI = 0.050, p < 0.001) and from 0.655 to 0.669 in the internal validation cohort (LRT, p = 0.033; NRI = 0.313, p = 0.148; IDI = 0.029, p = 0.044). The nomogram showed good discrimination, calibration, and clinical utility in both cohorts. Conclusions: HDS provided incremental prognostic information beyond TNM stage and LVI in CRC. The HDS‐based nomogram may facilitate individualized prognostic assessment, although external multicenter validation is required.
SN - 2045-7634
ER -