Intensity Of Tumor Budding As An Index For Malignancy Potential In Invasive Colorectal Carcinoma

Intensity of Tumor Budding as an Index for Malignancy Potential in Invasive Colorectal CarcinomaPurpose:The aims of this study were to investigate the relationship between the intensity of tumor budding and malignancy potential in colorectal carcinoma in order to determine how it correlates with oncologic outcome.Methods:Surgical specimens from 244 patients with well-or moderately-differentiated colorectal carcinoma were retrieved for semi-quantitative assessment of tumor budding at the invasive margin by hematoxylin-eosin stain.Differences in intensity among pathologic parameters were compared,and survivals were analyzed in accordance with the degree of its intensity.Results:Tumor budding was identified in 225 patients(92%)with a mean intensity of 6.7±5.5.The intensity was significantly higher in tumors with lymphatic(p＜0.0001),venous(p＜0.0001),and perineural invasion(p=0.0004)than in those without,and became significantly higher with increasing T and N stage(p=0.0076 and＜0.0001,respectively).In Dukes C diseases,cases showing relapse postoperatively displayed significantly higher intensity than those without relapse(p= 0.0006).When patients were stratified into two groups on either side of the mean of intensity,the higher group showed significantly less favorable outcome in terms of 5-year disease-free survival in Dukes C(43.9%vs.75%;p=0.013).Based on multivariate analysis,the intensity of budding proved to be an independent variable associated with disease-free survival(hazard ratio,2.005;95%confidence interval, 1.021-3.934;p=0.0432).