Abstract
Simple SummaryTo obtain the optimal treatment effect of endoscopic resection (ER) in early gastric carcinoma (EGC), a well-established indication for post-ER surgery is needed. In addition, accurate prediction of lymph node metastasis (LNM) is necessary to achieve this goal. Here, we present modified tumor budding (mTB), which excludes signet ring cells from conventional tumor budding (TB) as a novel predictor for LNM. Conventional TB and mTB were the most predictive independent factors for LNM. Furthermore, mTB was superior to TB in predicting LNM (p = 0.0004–0.0008). In conclusion, mTB significantly enhanced the predictive power of LNM, which could be a novel indicator for determining post-ER surgery.Endoscopic resection (ER) is a minimally invasive treatment for early gastric cancer (EGC) with a low risk of lymph node metastasis (LNM). Recently, tumor budding (TB) has emerged as a potential predictor of LNM in EGC. We assessed the clinical significance of modified TB (mTB) that excludes the signet ring cell component and compared several TB assessment methods. Two hundred and eighty-nine patients with EGC at Uijeongbu St. Mary’s Hospital from 2010 to 2021 were enrolled. In univariate analysis, age, size, depth of invasion, tumor type, histologic type, Lauren classification, lymphatic invasion, venous invasion, poorly differentiated carcinoma (“not otherwise specified” predominant), and TB were significantly associated with LNM. Multivariate regression analysis showed that mTB (difference area under the curve [dAUC] = 0.085 and 0.087) was superior to TB (dAUC = 0.054 and 0.057) in predicting LNM. In addition, total TB counts on representative slide sections (dAUC = 0.087 and 0.057) in assessing TB and mTB and the ITBCC method (dAUC = 0.085) in mTB were superior to the presence or absence method (dAUC = 0.042 and 0.029). The mTB significantly increases LNM prediction ability, which can provide important information for patients with EGC.
Highlights
PNC, tumor budding (TB) and modified TB (mTB) were significantly associated with lymph node metastasis (LNM) in overall
early gastric cancer (EGC), early gastric carcinoma; signet ring cells (SRCs), signet ring cell; LNM, lymph node metastasis; TB-YN, presence or absence of tumor budding; TB-ITBCC, method proposed by International Tumor Budding Consensus Conference; total-TB, total numbers of tumor budding on a whole slide. *
Our study revealed that TB, regardless of the evaluation method, was the most predictive independent factor for LNM, for groups containing all kinds of EGCs, such as intramucosal, submucosal, intestinal-type and diffuse-type, in addition to other independent risk factors, such as lymphatic invasion and advanced age (Table 3 and Figure 3)
Summary
The expanded indication was designed to apply ER to an undifferentiated-type adenocarcinoma; the LNM risk for the expanded indication may be less than 1%, but sufficient evidence is lacking [1] Despite these criteria for ER [1], extragastric recurrence after ER was reported in. Tumor budding (TB) is a well-known risk factor for LNM in early-stage colorectal cancer [10,11,12,13]. Studies on the association between TB and LNM in GC have been conducted mainly in intestinal-type carcinoma [12,14,19], as it is difficult to discern TB in poorly cohesive carcinoma (PCC) cases because of its discohesive pattern [16,20]. TB (i.e., peritumoral budding (PTB)) is difficult to apply in mucosal GC due to the lack of clear demarcation of the invasive front, and TB is reported to be correlated with LNM in both intratumoral budding (ITB) and PTB [12,24,25]
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