Abstract
ObjectiveWe aimed to develop the tumor budding (TB) score and to explore the association between the TB score and overall survival (OS) in patients with pancreatic ductal adenocarcinoma (PDAC).MethodsIn this retrospective study, 130 consecutive patients with PDAC underwent surgical resection between July 2016 and March 2019. The location and counts of TB were assessed based on the digitalized whole slide hematoxylin and eosin images. The TB score was achieved using the Cox regression equation. The cutoff point for the TB score was determined by X-tile. Univariate and multivariate Cox regression models were used to analyze the association between the TB score and OS.ResultsThe TB score was 0.49 (range = 0–1.08), and the best cutoff for the TB score was 0.62. The duration of survival in individuals with a low TB score [median = 21.8 months, 95% confidence interval (CI) = 15.43–25.50] was significantly longer than that in those with a high TB score (median = 11.33 months, 95% CI = 9.8–14.22). Univariate analysis revealed that the TB score was significantly associated with OS [hazard ratio (HR) = 2.71, 95% CI = 1.48–4.96, p = 0.001]. Multivariate analysis revealed a strong and independent association between the TB score and OS (HR = 2.35, 95% CI = 1.27–4.33, p = 0.03). The high TB score group had a 2.14 times higher mortality than the low TB score group.ConclusionThe TB score is strongly and independently associated with the risk of OS in PDAC.
Highlights
Pancreatic ductal adenocarcinoma (PDAC) is a highly fatal malignancy with a 5-year survival rate of only 9% and was the seventh leading cause of cancer-related death in both sexes worldwide in 2018 [1]
The duration of survival in individuals with a low Tumor budding (TB) score [median = 21.8 months, 95% confidence interval (CI) = 15.43–25.50] was significantly longer than that in those with a high TB score
Univariate analysis revealed that the TB score was significantly associated with overall survival (OS) [hazard ratio (HR) = 2.71, 95% CI = 1.48–4.96, p = 0.001]
Summary
Pancreatic ductal adenocarcinoma (PDAC) is a highly fatal malignancy with a 5-year survival rate of only 9% and was the seventh leading cause of cancer-related death in both sexes worldwide in 2018 [1]. TB was first proposed for colorectal cancer and has been recognized as a marker of aggressiveness or adverse prognostic factor of events [6, 7]. It has been reported that TB in patients with PDAC has a clear association with the process of EMT and adverse prognosis [12,13,14,15,16,17]. We aimed to develop a TB score combining the budding count and location based on whole slide pathology images of large sections and to further explore the association between the TB score and overall survival (OS) in patients with PDAC
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