Composite scoring system and optimal tumor budding cut-off number for estimating lymph node metastasis in submucosal colorectal cancer

Abstract

Background Tumor budding is associated with lymph node (LN) metastasis in submucosal colorectal cancer (CRC). However, the rate of LN metastasis associated with the number of tumor buds is unknown. Here, we determined the optimal tumor budding cut-off number and developed a composite scoring system (CSS) for estimating LN metastasis of submucosal CRC. Methods In total, 395 patients with histologically confirmed T1N0–2M0 CRC were evaluated. The clinicopathological characteristics were subjected to univariate and multivariate analyses. The Akaike information criterion (AIC) values of the multivariate models were evaluated to identify the optimal cut-off number. A CSS for LN metastasis was developed using independent risk factors. Results The prevalence of LN metastasis was 13.2%. Histological differentiation, lymphatic or venous invasion, and tumor budding were associated with LN metastasis in univariate analyses. In multivariate models adjusted for histological differentiation and lymphatic or venous invasion, the AIC value was lowest for five tumor buds. Unfavorable differentiation (odds ratio [OR], 8.16; 95% confidence interval [CI], 1.80–36.89), lymphatic or venous invasion (OR, 5.91; 95% CI, 2.91–11.97), and five or more tumor buds (OR, 3.01; 95% CI, 1.21–7.69) were independent risk factors. In a CSS using these three risk factors, the rates of LN metastasis were 5.6%, 15.5%, 31.0%, and 52.4% for total composite scores of 0, 1, 2, and ≥ 3, respectively. Conclusions For the estimation of LN metastasis in submucosal CRC, the optimal tumor budding cut-off number was five. Our CSS can be utilized to estimate LN metastasis.

Additional staining for lymphovascular invasion is associated with increased estimation of lymph node metastasis in patients with T1 colorectal cancer: Systematic review and meta‐analysis

“…We identified 3451 records from various databases until December 10, 2022. After screening for duplicates, we included 64 studies with 18,097 patients, 17,18,22,36–96 of them, 59 studies evaluated the diagnostic accuracies of HE and additional staining for LVI in LNM in patients with T1 CRC, four reported the interobserver agreement among pathologists for positive LVI, and one reported both outcomes, with eight studies comprising 4062 patients in multivariable analysis.…”

Effects of tumour budding on adjuvant chemotherapy in colorectal cancer

“…TB is a highly invasive tumour subpopulation that can evade the immune response 27 , 28 . As an emerging prognostic biomarker in CRC 11 , 29 , 30 , it has been strongly correlated with higher tumour grade, the presence of lymph node metastases and perineural invasion 12 , 13 . The prognostic value of TB has been validated in five independent studies, involving a total of 1978 patients with stage II CRC 14–18 .…”

“…Tumour budding (TB) was first described by Imai in the 1950s 10 and is defined as the presence of single cancer cells or clusters of up to four cells at the invasive tumour front 11 . It has been found to be strongly correlated with higher tumour grade, the presence of lymph node metastases, perineural invasion and immune escape 12 , 13 . Five independent studies demonstrated that patients with low-grade tumour budding (Bd1) had a 5-year disease-specific survival (DSS) of 89–98 per cent, while patients with intermediate-grade (Bd2) or high-grade tumour budding (Bd3) have a significantly worse 5-year DSS of 52–80 per cent 14–18 .…”

To study the utility of tumor budding as a histopathological marker in comparison to various histopathological parameters and TNM staging in breast carcinoma

“…Breast cancer is among the commonest cancers diagnosed in females. 1 Breast cancer is the main cause of death and is the most diagnosed cancer, exceeding lung cancer. Breast cancer is ranked first among Indian females, 2 and men contributes 0.5 to 1% of breast cancers.…”

“…A total of 7.8 million women who diagnosed with breast cancer in the past 5 years were alive at the end of 2020. 1,3 Breast cancer is a risk in both rural and urban India and it accounts for 14% cancers in India. A breast cancer case in Indian women is diagnosed every four minutes.…”