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PLCRC-UNITED: Uniform Noting for International Application of the Tumor-Stroma Ratio as an Easy Diagnostic Tool: Chemotherapy or not?



The treatment of colon cancer is highly dependent on the stage at the time of diagnosis. The current stage classification is used as guideline for the selection of patients for chemotherapy after surgery, but it needs improvement. In recent years, the tumor microenvironment, such as the supporting tissue (stroma), has been extensively researched and it has been shown to have a major influence on the aggressiveness of cancer. Patients with a tumor with a high amount of stroma have a shorter survival than patients with a tumor with a low amount of stroma. This ratio, expressed in the so-called tumor-stroma ratio (TSR), can support the stage classification in the selection of patients who could benefit of chemotherapy or not.



The aim of the UNITED is to prove that the TSR is a prognostic parameter in colorectal cancer. Subsequently, the TSR can be included in the guidelines and standard determined in tumors. In the consulting room this could lead to extra support for a personalized treatment process.


Research design

The UNITED study is an international trial in which 1500 colon cancer patients will participate. During their standard trajectory, only the TSR is additionally scored by certified pathologists on the already collected tissue, which is used for the diagnosis. The data, which is already requested during the standard outpatient checks, will also be collected for 3 years after the operation. This way, it can be determined whether the amount of stroma ultimately influences survival. In the Dutch centers, the participating patients are collected through collaboration with PLCRC. The results will be used to prepare a proposal to adjust the current stage classification.


Additional information