Intensity of Tumor Budding and Its Prognostic Implications in Invasive Colon Carcinoma

Park, Ki-Jae; Choi, Hong-Jo; Roh, Mee‐Sook; Kwon, Hyuk‐Chan; Kim, Choongrak

doi:10.1007/s10350-005-0060-6

Cited by 84 publications

(83 citation statements)

References 21 publications

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“…13,14,[19][20][21] Although the number of tumor buds as well as the costs are likely to be higher using this approach, it is of significant benefit to differentiate them from activated fibroblasts in the surrounding stroma. Hence, the assessment of budding in this study was undertaken after staining with a pan-cytokeratin antibody of the most representative tumor block.…”

Section: Discussionmentioning

confidence: 99%

Proposal for a 10-high-power-fields scoring method for the assessment of tumor budding in colorectal cancer

et al. 2013

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Although tumor budding is linked to adverse prognosis in colorectal cancer, it remains largely unreported in daily diagnostic work due to the absence of a standardized scoring method. Our aim was to assess the interobserver agreement of a novel 10-high-power-fields method for assessment of tumor budding at the invasive front and to confirm the prognostic value of tumor budding in our setting of colorectal cancers. Whole tissue sections of 215 colorectal cancers with full clinico-pathological and follow-up information were stained with cytokeratin AE1/AE3 antibody. Presence of buds was scored across 10-high-power fields at the invasive front by two pathologists and two additional observers were asked to score 50 cases of tumor budding randomly selected from the larger cohort. The measurements were correlated to the patient and tumor characteristics. Inter-observer agreement and correlation between observers' scores were excellent (Po0.0001; intraclass correlation coefficient ¼ 0.96). A test subgroup of 65 patients (30%) was used to define a valid cutoff score for high-grade tumor budding and the remaining 70% of the patients were entered into the analysis. High-grade budding was defined as an average of Z10 buds across 10-high-power fields. High-grade budding was associated with a higher tumor grade (Po0.0001), higher TNM stage (P ¼ 0.0003), vascular invasion (Po0.0001), infiltrating tumor border configuration (Po0.0001) and reduced survival (Po0.0001). Multivariate analysis confirmed its independent prognostic effect (P ¼ 0.007) when adjusting for TNM stage and adjuvant therapy. Using 10-high-power fields for evaluating tumor budding has independent prognostic value and shows excellent inter-observer agreement. Like the BRE and Gleason scores in breast and prostate cancers, respectively, tumor budding could be a basis for a prognostic score in colorectal cancer.

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Section: Discussionmentioning

confidence: 99%

Proposal for a 10-high-power-fields scoring method for the assessment of tumor budding in colorectal cancer

et al. 2013

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“…A significant association between tumor budding and lymph node positivity has been consistently demonstrated correlating with tumor aggressiveness and more advanced TNM stage [32][33][34][35][36][37][38][39][40][41][42][43] . Tumor budding is frequently associated with poorly differentiated tumors, and with the presence of vascular and lymphatic invasion independently of disease extent [44][45][46][47][48] . Local tumor recurrence and distant metastasis to the lung and liver are also more commonly observed in patients with tumor budding [36,39,[48][49][50] and additionally represent a reproducible prognostic factor in stage Ⅱ patients [51] .…”

Section: Prognostic Impact Of Tumor Buddingmentioning

confidence: 99%

Invasive front of colorectal cancer: Dynamic interface ofpro-/anti-tumor factors

Zlobec¹,

Lugli²

2009

WJG

107

101

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“…Various elaborate systems for quantification of tumor budding in colorectal cancer have been described. 3,8,[11][12][13][14][15][16][17][18][19] All of these tumor budding grading systems share an association of high peri-tumoral budding with a worse outcome.…”

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confidence: 99%

Intra-tumoral budding in preoperative biopsy specimens predicts lymph node and distant metastasis in patients with colorectal cancer

et al. 2012

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Tumor budding, a histological hallmark of epithelial-mesenchymal transition in colorectal cancer, is a parameter of tumor progression and according to the International Union Against Cancer/American Joint Committee on Cancer an 'additional' prognostic factor. The current definition of tumor budding is reserved for the invasive tumor front of colorectal cancer (so called peri-tumoral budding), but tumor buds can also be observed in small preoperative biopsy specimens. Whereas the prognostic value of peri-tumoral budding assessed in resection specimens has found wide acceptance, the value of budding in preoperative biopsies, which normally do not encompass the invasive tumor margin and hence can be called intra-tumoral budding, has not been systematically investigated yet. Therefore, the aim of this study is to assess the predictive value of intra-tumoral budding for lymph node and distant metastasis in preoperative biopsies. Preoperative biopsy samples and consecutive resection specimens from 72 patients with pathological information on TNM stage, vascular, lymphatic and perineural invasion, and tumor border configuration were used to evaluate intra-tumoral budding and peri-tumoral budding. Both parameters were scored semiquantitatively as 'high' (detectable at low power magnification Â 2.5) and 'low' (occasional budding at intermediate magnification Â 10, difficult to find or absent). In biopsy samples high intratumoral budding was observed in 12/72 patients (17%) and associated with high peri-tumoral budding in the corresponding resection specimens (P ¼ 0.008). Additionally, there was a correlation between high intra-tumoral budding and lymph node metastasis (P ¼ 0.034), distant metastasis (P ¼ 0.007) and higher tumor grade (P ¼ 0.025). Peri-tumoral budding was associated with higher N stage (P ¼ 0.004), vascular (P ¼ 0.046) and lymphatic invasion (P ¼ 0.019) as well as with an infiltrating tumor border (Po0.001), reflecting the predictive power of peri-tumoral budding for tumor progression. High intra-tumoral budding in preoperative biopsy samples of colorectal cancer patients predicts high peri-tumoral budding at the invasive margin and lymph node metastasis in the corresponding resection specimens as well as distant metastasis.

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Intensity of Tumor Budding and Its Prognostic Implications in Invasive Colon Carcinoma

Abstract: The intensity of tumor budding at the invasive margin is suggested to be a significant pathologic index, indicating higher malignancy potential and the intensity greater than nine may be considered an adverse prognostic indicator in patients with colon carcinoma.

Cited by 84 publications

References 21 publications

Proposal for a 10-high-power-fields scoring method for the assessment of tumor budding in colorectal cancer

Proposal for a 10-high-power-fields scoring method for the assessment of tumor budding in colorectal cancer

Invasive front of colorectal cancer: Dynamic interface ofpro-/anti-tumor factors

Intra-tumoral budding in preoperative biopsy specimens predicts lymph node and distant metastasis in patients with colorectal cancer

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