Prognostic value of DNA ploidy and automated assessment of stroma fraction in prostate cancer

Int J Cancer. 2020 Aug 15;147(4):1228-1234. doi: 10.1002/ijc.32832. Epub 2020 Jan 2.


The combination of DNA ploidy and automatically estimated stroma fraction has been shown to correlate with recurrence and cancer death in colorectal cancer. We aimed to extend this observation and evaluate the prognostic importance of this combined marker in prostate cancer. DNA ploidy status was determined by image cytometry and the stroma fraction was estimated automatically on hematoxylin and eosin stained sections in three tumor samples from each patient to account for tumor heterogeneity. The optimal threshold for low (≤56%) and high (>56%) stroma fraction was identified in a discovery cohort (n = 253). The combined marker was validated in an independent patient cohort (n = 259) with biochemical recurrence as endpoint. The combined marker predicted biochemical recurrence independently in the validation cohort. Multivariable analysis showed that the highest risk of recurrence was observed for patients with samples that had both non-diploid ploidy status and a high stroma fraction (hazard ratio: 2.51, 95% confidence interval: 1.18-5.34). In conclusion, we suggest the combination of DNA ploidy and automatically estimated stroma fraction as a prognostic marker for the risk stratification of prostate cancer patients. It may also be a potential generic marker as concurrent results have been described in colorectal cancer.

Keywords: DNA ploidy; digital image analysis; intra-tumor heterogeneity; prostate cancer; stroma fraction.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Automation, Laboratory / methods*
  • Biomarkers, Tumor / genetics*
  • Biomarkers, Tumor / metabolism
  • Cohort Studies
  • DNA, Neoplasm / genetics*
  • Flow Cytometry / methods
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Recurrence, Local
  • Ploidies*
  • Prognosis
  • Prostatectomy
  • Prostatic Neoplasms / diagnosis*
  • Prostatic Neoplasms / genetics
  • Prostatic Neoplasms / metabolism
  • Risk Factors
  • Staining and Labeling / methods*


  • Biomarkers, Tumor
  • DNA, Neoplasm