Tumor-stromal ratio as a predictive marker for lymph node metastasis in patients with oral cavity squamous cell carcinoma: a cross-sectional study
- 1Department Of Surgical Oncology, Madurai Medical College, Madurai, India
Abstract
Objective: The prognostic potential of the tumor-stromal ratio (TSR) in esophageal, colon, breast, cervical, and oral squamous cell carcinomas (OSCC) has been well documented. Lymph node involvement is a critical prognostic factor in oral cavity cancers, and understanding its association with histopathological features may improve prognostic assessments. This study aimed to evaluate the association between TSR and lymph node metastasis (LNM) in patients with oral cavity squamous cell carcinoma.
Methods: A cross-sectional study was conducted on 55 patients diagnosed with oral cavity squamous cell carcinoma who underwent upfront surgical treatment. Tumor specimens were assessed for TSR, defined as the proportion of tumor cells relative to the total tumor area (tumor cells plus stroma), using routine hematoxylin and eosin (H&E)-stained slides. A TSR ≥ 50% was classified as the tumor-rich (high TSR) group, and TSR < 50% as the stroma-rich (low TSR) group. The association between TSR and lymph node metastasis was analyzed using Pearson’s chi-square test and Fisher’s exact test where appropriate.
Results: A significant association was observed between high TSR and the presence of lymph node metastasis (p < 0.001). In the high TSR group (n = 26), 20 patients (76.9%) had lymph node metastasis, compared with 7 patients (24.1%) in the low TSR group (n = 29). The positive predictive value (PPV) was 74.04% and the negative predictive value (NPV) was 78.5%. TSR was also significantly associated with tumor grade (p < 0.001), lymphovascular space invasion (LVSI) (p < 0.001), and tumor size (p = 0.002).
Conclusion: TSR, assessed on routine H&E-stained slides, is significantly associated with lymph node metastasis in oral cavity squamous cell carcinoma. It represents a simple, cost-effective histopathological parameter that may aid in predicting nodal spread and informing treatment planning. Further prospective studies with larger cohorts are warranted to validate these findings.
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BibTeX
@article{muthuvel2026tumorstromal,
title = {{Tumor-stromal ratio as a predictive marker for lymph node metastasis in patients with oral cavity squamous cell carcinoma: a cross-sectional study}},
author = {Ramesh Muthuvel and Mohamed Ibrahim Maroof Saheb and Gurumoorthy A. N. and Satish Kumar M.},
journal = {BMC Cancer},
year = {2026},
month = aug,
doi = {10.1186/s12885-026-16461-w},
url = {https://doi.org/10.1186/s12885-026-16461-w},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Tumor-stromal ratio as a predictive marker for lymph node metastasis in patients with oral cavity squamous cell carcinoma: a cross-sectional study
AU - Ramesh Muthuvel
AU - Mohamed Ibrahim Maroof Saheb
AU - Gurumoorthy A. N.
AU - Satish Kumar M.
PY - 2026
DA - 2026/08/06
JO - BMC Cancer
DO - 10.1186/s12885-026-16461-w
UR - https://doi.org/10.1186/s12885-026-16461-w
AB - Objective: The prognostic potential of the tumor-stromal ratio (TSR) in esophageal, colon, breast, cervical, and oral squamous cell carcinomas (OSCC) has been well documented. Lymph node involvement is a critical prognostic factor in oral cavity cancers, and understanding its association with histopathological features may improve prognostic assessments. This study aimed to evaluate the association between TSR and lymph node metastasis (LNM) in patients with oral cavity squamous cell carcinoma. Methods: A cross-sectional study was conducted on 55 patients diagnosed with oral cavity squamous cell carcinoma who underwent upfront surgical treatment. Tumor specimens were assessed for TSR, defined as the proportion of tumor cells relative to the total tumor area (tumor cells plus stroma), using routine hematoxylin and eosin (H&E)-stained slides. A TSR ≥ 50% was classified as the tumor-rich (high TSR) group, and TSR < 50% as the stroma-rich (low TSR) group. The association between TSR and lymph node metastasis was analyzed using Pearson’s chi-square test and Fisher’s exact test where appropriate. Results: A significant association was observed between high TSR and the presence of lymph node metastasis (p < 0.001). In the high TSR group (n = 26), 20 patients (76.9%) had lymph node metastasis, compared with 7 patients (24.1%) in the low TSR group (n = 29). The positive predictive value (PPV) was 74.04% and the negative predictive value (NPV) was 78.5%. TSR was also significantly associated with tumor grade (p < 0.001), lymphovascular space invasion (LVSI) (p < 0.001), and tumor size (p = 0.002). Conclusion: TSR, assessed on routine H&E-stained slides, is significantly associated with lymph node metastasis in oral cavity squamous cell carcinoma. It represents a simple, cost-effective histopathological parameter that may aid in predicting nodal spread and informing treatment planning. Further prospective studies with larger cohorts are warranted to validate these findings.
SN - 1471-2407
ER -