***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background The study aim ed to determine the prognostic impact of clinical and pathological factors on survival among patients with small cell neuroendocrine carcinoma ( SNEC ) , adenocarcinoma ( ADC ) , and squamous cell carcinoma ( SCC ) . Methods Eligible participants were all patients with histologically confirmed cervical cancer treated at Chiang Mai University Hospital between 1995 and 2011 . We included all patients with SNEC and r and omly enrolled patients with ADC and SCC .  We used competing-risk regression analysis to examine the risk of cancer-related death by histological type . Results We included 130 ( 6.2 % ) women with SNEC , 346 ( 16.4 % ) with ADC , and 1,632 ( 77.4 % ) with SCC . Age > 60 years ( hazard ratio [ HR ] 4.9 , 95 % confidence interval [ CI ] 2.0–12.0 ) and lymph node involvement ( HR 3.0 , 95 % CI 1.2–7.4 ) were prognostic factors among surgically-treated patients with SNEC .  Deeper stromal invasion ( HR 3.6 , 95 % CI 1.6–8.3 ) was a prognostic factor in patients with SCC . In patients with advanced SNEC , age > 60 years had a strong prognostic impact ( HR 2.6 , 95 % CI 1.0–6.5 ) while the International Federation of Gynecology and Obstetrics stages III and IV were prognostic factors for patients with advanced stage ADC ( HR 2.9 , 95 % CI 2.0–4.4 and HR 4.5 , 95 % CI 2.6–7.9 , respectively ) and SCC ( HR 1.7 , 95 % CI 1.4–2.0 and HR 3.7 , 95 % CI 2.8–4.9 , respectively ) compared with the International Federation of Gynecology and Obstetrics stage IIB . Conclusion Clinical and pathological prognostic factors in cervical cancer differed according to histological type . Taking the important prognostic factors for each histological type into consideration may be beneficial for tailored treatment and follow-up planning BACKGROUND Clarifying the prognostic impact of histological type is an essential issue that may influence the treatment and follow-up planning of newly diagnosed cervical cancer cases . This study aim ed to evaluate the prognostic impact of histological type on survival and mortality in patients with cervical squamous cell carcinoma ( SCC ) , adenocarcinoma ( ADC ) and small cell neuroendocrine carcinoma ( SNEC ) . MATERIAL S AND METHODS All patients with cervical cancer diagnosed and treated at Chiang Mai University Hospital between January 1995 and October 2011 were eligible . We included all patients with SNEC and a r and om weighted sample of patients with SCC and ADC .  We used competing-risks regression analysis to evaluate the association between histological type and cancer-specific survival and mortality . RESULTS Of all 2,108 patients , 1,632 ( 77.4 % ) had SCC , 346 ( 16.4 % ) had ADC and 130 ( 6.2 % ) had SNEC .  Overall , five-year cancer-specific survival was 60.0 % , 54.7 % , and 48.4 % in patients with SCC , ADC and SNEC , respectively . After adjusting for other clinical and pathological factors , patients with SNEC and ADC had higher risk of cancer-related death compared with SCC patients ( hazard ratio [ HR ] 2.6 ; 95 % CI , 1.9 - 3.5 and HR 1.3 ; 95 % CI , 1.1 - 1.5 , respectively ) . Patients with SNEC were younger and had higher risk of cancer-related death in both early and advanced stages compared with SCC patients ( HR 4.9 ; 95 % CI , 2.7 - 9.1 and HR 2.5 ; 95 % CI , 1.7 - 3.5 , respectively ) . Those with advanced-stage ADC had a greater risk of cancer-related death ( HR 1.4 ; 95 % CI , 1.2 - 1.7 ) compared with those with advanced-stage SCC , while no significant difference was observed in patients with early stage lesions . CONCLUSION Histological type is an important prognostic factor among patients with cervical cancer in Thail and . Though patients with SNEC were younger and more often had a diagnosis of early stage compared with ADC and SCC , SNEC was associated with poorest survival . ADC was associated with poorer survival compared with SCC in advanced stages , while no difference was observed at early stages . Further tailored treatment-strategies and follow-up planning among patients with different histological types should be considered 
    Output:
    
The effect of low TSR on poor OS was observed among various cancer types , but not in the early stage of cervical caner .
Subgroup analyses indicated that cancer type , clinical stage , study region , blinding status , and NOS score did not affect the prognostic value of  TSR for DFS .
Moreover , low TSR was significantly correlated with the serious clinical stage , advanced depth of invasion , and positive lymph node metastasis .
These findings indicate that a high proportion of stroma in cancer tissue is associated with poor clinical outcomes in cancer patients , and TSR may serve as an independent prognostic factor for solid tumors