Tumor budding and evidence-based treatment of T2 rectal carcinomas

Abstract

A number of tumor budding may be useful for determining the individualized treatment of T2 rectal carcinomas.

Tumor budding in colorectal carcinoma: time to take notice

“…There is a strong association between budding and the presence of lymph node metastases and lymphovascular invasion, 11,12,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] defined by the presence of tumor cells within an endothelium-lined space, and it has been suggested that buds represent the part of the tumor that has gained the ability to invade lymphatics and vascular channels. This idea is supported by two intriguing morphological studies: Morodomi et al 33 examined serial sections of high-budding areas to demonstrate that budding nests are often found adjacent to areas of lymphovascular space invasion, and, in a more recent study, Ohtsuki et al 31 performed double staining for anti-cytokeratin antibodies and anti-lymphatic antibodies, finding that a number of 'buds' at the invasive edge of a tumor are in fact located in small lymphatic spaces.…”

“…11,12,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] On multivariate analysis, budding has consistently emerged as an independent adverse prognostic factor, associated with local tumor recurrence and distant metastases, and significantly worse overall and disease-free survival. 12,15,16,21,27,28,31,32,[34][35][36]38,40,41 The adverse prognostic impact of high-grade tumor budding is seen in both early and advanced colorectal carcinoma, and there are several scenarios in which this feature might influence clinical decision making, particularly in early colorectal carcinoma.…”

“…Although most authors have used Ueno's definition of 'highgrade budding' (410 buds of fewer than 5 cells), all have used a 20 Â objective, rather than the 25 Â objective used by Ueno et al, resulting in significantly greater field areas than that originally reported by Ueno. Furthermore, while the majority of studies have evaluated only areas with the greatest amount of budding, others have proposed calculating an average bud count, 11 counting the number of buds along the entire invasive front 19,24,52,53 or calculating the proportion of invasive front with tumor budding. 21,36,40 Such methodological heterogeneity is illustrated in Table 1, which summarizes the bud counting methods used in a sample of tumor-budding studies.…”

“…The results and methodologies of these studies are summarized in Table 2. In addition, Masaki et al 24,53 have proposed a formula based on the total number of buds counted along the entire invasive margin to predict the probability of lymph node metastases in T1 and T2 colorectal carcinoma: although this is an interesting idea, it is not practical for use in everyday practice.…”

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

“…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.…”