Inti Zlobec1, Heather E Dawson2, Annika Blank2, John-Melle Bokhorst3, Martin D Berger4, Iris D Nagtegaal3, Alessandro Lugli2. 1. Institute of Pathology, University of Bern, Murtenstrasse 31, CH-3008, Switzerland. Electronic address: inti.zlobec@pathology.unibe.ch. 2. Institute of Pathology, University of Bern, Murtenstrasse 31, CH-3008, Switzerland. 3. Department of Pathology, Radboud University Medical Center, Nijmegen, Netherlands. 4. Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
Abstract
BACKGROUND: Tumour grade is traditionally considered in the management of patients with colorectal cancer. However, a large body of literature suggests that a related feature, namely tumour budding, may have a more important clinical impact. The aim of our study is to determine the correlation between tumour grade and tumour budding and their impact on patient outcome. METHODS: A retrospective collective of 771 patients with colorectal cancer were included in the study. Clinicopathological information included tumour grade (World Health Organisation 2010; G1, G2 and G3) and tumour budding evaluated as BD1, BD2 and BD3 and representing 0-4 buds, 5-9 buds and 10 or more buds per 0.785 mm2, respectively. RESULTS: Tumour grade and tumour budding were correlated (p < 0.0001, percent concordance: 33.8%). Of the BD1 cases, 18.1% were of G3. Only two BD3 cases were G1. Both high tumour grade and tumour budding were associated with higher pT, lymph node metastasis, distant metastasis and lymphatic and venous vessel invasion (p < 0.01, all), but only tumour grade was additionally associated with right-sided tumour location and mucinous histology. Higher tumour budding led to worse overall (p = 0.0286) and disease-free survival (p = 0.001), but tumour grade did not. Budding was independent of tumour grade in multivariate analysis. DISCUSSION: Tumour grade and tumour budding are distinct features, as recognised by their different clinicopathological associations, reflecting different underlying biological processes. Nonetheless, tumour budding seems to outperform tumour grade in terms of predicting disease-free survival.
BACKGROUND:Tumour grade is traditionally considered in the management of patients with colorectal cancer. However, a large body of literature suggests that a related feature, namely tumour budding, may have a more important clinical impact. The aim of our study is to determine the correlation between tumour grade and tumour budding and their impact on patient outcome. METHODS: A retrospective collective of 771 patients with colorectal cancer were included in the study. Clinicopathological information included tumour grade (World Health Organisation 2010; G1, G2 and G3) and tumour budding evaluated as BD1, BD2 and BD3 and representing 0-4 buds, 5-9 buds and 10 or more buds per 0.785 mm2, respectively. RESULTS:Tumour grade and tumour budding were correlated (p < 0.0001, percent concordance: 33.8%). Of the BD1 cases, 18.1% were of G3. Only two BD3 cases were G1. Both high tumour grade and tumour budding were associated with higher pT, lymph node metastasis, distant metastasis and lymphatic and venous vessel invasion (p < 0.01, all), but only tumour grade was additionally associated with right-sided tumour location and mucinous histology. Higher tumour budding led to worse overall (p = 0.0286) and disease-free survival (p = 0.001), but tumour grade did not. Budding was independent of tumour grade in multivariate analysis. DISCUSSION: Tumour grade and tumour budding are distinct features, as recognised by their different clinicopathological associations, reflecting different underlying biological processes. Nonetheless, tumour budding seems to outperform tumour grade in terms of predicting disease-free survival.
Authors: Moritz Jesinghaus; Anna-Lina Herz; Meike Kohlruss; Miguel Silva; Albert Grass; Sebastian Lange; Alexander Novotny; Katja Ott; Thomas Schmidt; Matthias Gaida; Alexander Hapfelmeier; Carsten Denkert; Wilko Weichert; Gisela Keller Journal: J Pathol Clin Res Date: 2022-06-17