Abstract
BackgroundBudding is a complementary prognostic factor for colorectal cancer. In this study, we aimed to clarify the role of tumor budding in rectal cancer patients after preoperative chemoradiotherapy.MethodsA total of 124 patients with rectal cancer treated with neoadjuvant chemoradiotherapy and consecutive surgery were included. Surgical specimens were evaluated for budding and routine clinicopathological features. Budding was evaluated on hematoxylin and eosin (H&E)-stained slides and by cytokeratin immunohistochemical (IHC) staining.ResultsA budding rate of 36.9% (n = 38) by H&E and 55.6% (n = 55) by IHC was observed. Budding was significantly associated with a high ypT and ypN status, poor differentiation, and low degrees of tumor regression. Moreover, budding was strongly predictive of a worse patient outcome, as measured by tumor recurrence or death. In multivariate analyses, budding remained the only significant parameter for overall survival and was even superior to the ypT and ypN status (budding in H&E: hazard ratio (HR) 2.72, 95% confidence interval (95% CI) 1.15–6.44, p = 0.023; budding in IHC: HR 5.19, 95% CI 1.62–16.61, p = 0.006).ConclusionBudding is a strong prognostic predictor of survival in rectal cancer patients after neoadjuvant therapy. A standardized evaluation of tumor budding after neoadjuvant therapy may thus aid in risk stratification and guide the clinical management of patients with rectal cancer. Immunostaining can help to enhance the diagnostic accuracy and prognostic significance.
Highlights
Budding is a complementary prognostic factor for colorectal cancer
Evaluation of tumor budding by hematoxylin and eosin (H&E) and IHC In the following tumor budding analyses, we examined only specimens with residual tumor
Budding is an independent prognostic factor for diseasefree survival and overall survival in multivariate cox proportional hazards regression models In the multivariate analysis, budding scored on H&Estained sections (HR 2.34, 95% 95% confidence interval (CI) 1.14–4.79; p = 0.020) and ypT stage (HR 2.85, 95% confidence interval (95% CI) 1.16–7.02; p = 0.023) were both independent predictors of disease-free survival (Table 6)
Summary
Budding is a complementary prognostic factor for colorectal cancer. In this study, we aimed to clarify the role of tumor budding in rectal cancer patients after preoperative chemoradiotherapy. Since the implementation of this therapy, the risk for local recurrence has notably decreased, and sphincter-preserving surgery is more often performed [1, 2]. After such intensive therapy, the initial morphology of the tumor is subject to considerable changes. Trotsyuk et al BMC Cancer (2019) 19:1033 clarified as to whether they play a decisive role in the prognostic prediction of treated rectal cancer. They might constitute, a valuable addition to the TNM system and regression grading of treated rectal cancers. In colorectal carcinoma, budding is a strong adverse prognostic marker [4,5,6,7,8,9]
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