الفهرس 
Title : The Correlation between tumor-stroma ratio, E-cadherin expression, and the Morphologic Prognosticators in Different Stages of operable colorectal Adenocarcinoma
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Abstract
Background and Aim
Worldwide, CRC is the third most common cancer in men and the second most common in women. Alongside TNM staging, we are in a need to understand how CRC tumors’ behavior and their microenvironment influence their prognosis. EMT is one of the crosstalk between cancer prognosis & their variable microenvironment. We aimed to evaluate the prognostic value of tumor stroma ratio and study the expression of E-cadherin by tumor cells in the invasive front, tumor buds, and extracolonic foci of colorectal adenocarcinoma.
Methods
This retrospective cohort study included 70 primary CRC cases obtained by curative surgical and laparoscopic colectomy with lymphadenectomy& extra colonic nodule specimens during the period from May 2021 to March 2022. Demographic, histopathological data, and immunohistochemical were recorded.
Results
The study included 70 primary CRC cases. The mean age of the current study was 62.2 years ranging from 38 to 89 years old. According to the sex of cases; 57% of cases were females & 43% of cases were males. we observed a statistically significant association between high TSR and the presence of PNI, tumor invasiveness, the presence of extracolonic nodules, positive distant metastasis, and the pathology Tumor staging (p=0.008 p=0.038, p= 0.019, p=0.002, and p= 0.011) respectively. Also, we demonstrated a statistically significant association between tumor budding score and lymph node status, distant metastasis, LVI, PNI, and Tumor staging (P-value<0.001, P-value= 0.005, P- 0.003, P- 0.04, and p=<0.0001) respectively.we observed a significant correlation by using Spearman’s rho test between increased tumor budding score and decrease their E-Cadherin expression in invasive front and tumor buds ((P-value=0.005-value=0.01 and).
Conclusion
Tumor stromal ratio and tumor budding are applicable histopathological biomarkers. Tumors with stroma-high TSR are associated with tumor invasiveness and metastasis advocating the TSR as a prognostic factor besides clinicopathological parameters. The different clinicopathological parameters were adversely related to the tumor budding score. The invasive front and tumor budding of CRC tumors each loss E-cadherin expression with increasing tumors’ stage.