Prognostic Value Of Tumor Budding In Early Cervical Adenocarcinoma

Background:TB(Tumor Budding)is a common form of invasion of many malignant tumors.Some studies have found that high counts of TB are significantly associated with Lymph-vascular space invasion(LVSI),high histological grade,late stage,lymph node metastasis,distant metastasis,and poor prognosis for malignant tumors.but with regard to TB for early cervical adenocarcinoma,The impact of the prognosis is not clear.Objective:To investigate the relationship between the number of tumor budding in cervical adenocarcinoma and other clinicopathological features and its relationship with prognosis.Methods:Retrospective collection of radical hysterectomy and pelvic lymph node dissection for early stage(IB-IIA)common cervical adenocarcinoma from Dalian Maternal and Child Health Care Hospital from February 2006 to September 2013 The clinical and pathological data of 43 patients who underwent surgery and pathological findings confirmed that atypical types such as adenosquamous carcinoma and minimal deviation adenocarcinoma were excluded.All archival pathological slides were reviewed By two senior and experienced pathologists in Department of Pathology of Dalian Maternal and Child Health Care Hospital.Re-reading included:assessment of the number of tumor budding,histological grade,Depth of invasion Inner,lymph node metastasis,Lymph-vascular space invasion,and Parametrial involvement.Tumor budding was evaluated in routinely-stained sections and defined as detached single cells or clusters of fewer than 5 cells in a tumor invasive front and was stratified based on the number of bud counts in 10-high-power fields as low(<15 buds)and high(? 15 buds).The patients were followed up by telephone,home visit and other forms.The starting point of follow-up was:when the patients started the operation and the deadline for the follow-up was August 2018.The overall survival(OS)refers to the time between the start of surgery and the death of early cervical adenocarcinoma(or the deadline for follow-up of survivors)and the recurrence-free survival(RPS)refers to the time from the start of the surgical treatment until the patient has found a recurrence of the early cervical adenocarcinoma(or the deadline for follow-up of survivors).With SPSS23.0 statistical software for statistical analysis.Results:A total of 43 patients were enrolled in the study,with an average age of 46.4±8.8 years.FIGO staged 34 patients(79.1%),IB2 3(7.0%),and ?A 6(13.9%).Lymph node metastasis was performed in 8 patients(18.6%).The follow-up period was 14 to 146 months(median 90 months).Twelve patients(27.9%)had tumor recurrence,and 10 of them(23.3%)died of cervical cancer recurrence.The tumor budding range in 10 HPF ranged from 0 to 54(median 6).High tumor budding numbers were observed in 16 patients(37.2%)and low tumor bud numbers were observed in 27 patients(62.8%).Analysis showed that there was a significant correlation between the advanced FIGO stage(P=0.041),Depth of invasion Inner>1/2(P=0.000),lymph node metastasis(P=0.000),Lymphovascular space invasion(P=0.011),Silva C(P=0.011)and High tumor bud number.Kaplan-Meier analysis showed a significant reduction in disease-free survival and overall survival in patients with high tumor budding counts(both P=0.000).In multivariate analysis,high tumor sprouting was an independent poor prognostic factor for disease-free survival(P=0.004)and overall survival(P=0.005).Conclusions:(1)High TB number is associated with poor pathological factors such as higher FIGO stage,Lymphovascular space invasion,Depth of invasion Inner>1/2,Silva C and lymph node metastasis.(2)High TB count is associated with disease-free survival and overall cancer survival in patients with early cervical adenocarcinoma.(3)The number of tumor budding is an independent risk factor affecting the prognosis of patients with early cervical adenocarcinoma.