Clinical Pathology Division, University of Berne, Berne, Switzerland.
Mod Pathol. 2012 Jul;25(7):1048-53. doi: 10.1038/modpathol.2012.56. Epub 2012 Apr 6.
Tumor budding, a histological hallmark of epithelial-mesenchymal transition in colorectal cancer, is a parameter of tumor progression and according to the International Union Against Cancer/American Joint Committee on Cancer an 'additional' prognostic factor. The current definition of tumor budding is reserved for the invasive tumor front of colorectal cancer (so called peri-tumoral budding), but tumor buds can also be observed in small preoperative biopsy specimens. Whereas the prognostic value of peri-tumoral budding assessed in resection specimens has found wide acceptance, the value of budding in preoperative biopsies, which normally do not encompass the invasive tumor margin and hence can be called intra-tumoral budding, has not been systematically investigated yet. Therefore, the aim of this study is to assess the predictive value of intra-tumoral budding for lymph node and distant metastasis in preoperative biopsies. Preoperative biopsy samples and consecutive resection specimens from 72 patients with pathological information on TNM stage, vascular, lymphatic and perineural invasion, and tumor border configuration were used to evaluate intra-tumoral budding and peri-tumoral budding. Both parameters were scored semiquantitatively as 'high' (detectable at low power magnification × 2.5) and 'low' (occasional budding at intermediate magnification × 10, difficult to find or absent). In biopsy samples high intra-tumoral budding was observed in 12/72 patients (17%) and associated with high peri-tumoral budding in the corresponding resection specimens (P=0.008). Additionally, there was a correlation between high intra-tumoral budding and lymph node metastasis (P=0.034), distant metastasis (P=0.007) and higher tumor grade (P=0.025). Peri-tumoral budding was associated with higher N stage (P=0.004), vascular (P=0.046) and lymphatic invasion (P=0.019) as well as with an infiltrating tumor border (P<0.001), reflecting the predictive power of peri-tumoral budding for tumor progression. High intra-tumoral budding in preoperative biopsy samples of colorectal cancer patients predicts high peri-tumoral budding at the invasive margin and lymph node metastasis in the corresponding resection specimens as well as distant metastasis.
肿瘤芽殖，结直肠癌上皮间质转化的组织学标志，是肿瘤进展的一个参数，根据国际抗癌联盟/美国癌症联合委员会的定义，它是一个“附加”的预后因素。目前，肿瘤芽殖的定义仅限于结直肠癌的侵袭性肿瘤前缘（所谓的肿瘤周围芽殖），但也可以在小的术前活检标本中观察到肿瘤芽。虽然在切除标本中评估的肿瘤周围芽殖的预后价值已得到广泛认可，但在术前活检标本中芽殖的价值尚未得到系统研究，这些标本通常不包括侵袭性肿瘤边缘，因此可以称为肿瘤内芽殖。因此，本研究旨在评估术前活检标本中肿瘤内芽殖对淋巴结和远处转移的预测价值。使用术前活检样本和连续的切除标本，对 72 例有 TNM 分期、血管、淋巴和神经周围侵犯以及肿瘤边界形态学信息的患者进行肿瘤内芽殖和肿瘤周围芽殖评估。两个参数均采用半定量评分，“高”（低倍镜×2.5 下可检测到）和“低”（中倍镜×10 下偶尔出现芽殖，难以发现或不存在）。在 72 例患者的活检样本中，观察到 12 例（17%）存在高肿瘤内芽殖，且与相应的切除标本中高肿瘤周围芽殖相关（P=0.008）。此外，高肿瘤内芽殖与淋巴结转移（P=0.034）、远处转移（P=0.007）和较高的肿瘤分级（P=0.025）相关。肿瘤周围芽殖与较高的 N 分期（P=0.004）、血管侵犯（P=0.046）和淋巴侵犯（P=0.019）以及浸润性肿瘤边界（P<0.001）相关，反映了肿瘤周围芽殖对肿瘤进展的预测能力。结直肠癌患者术前活检标本中存在高肿瘤内芽殖可预测相应切除标本中高肿瘤周围芽殖、淋巴结转移以及远处转移。
