Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.
Mod Pathol. 2012 Oct;25(10):1315-25. doi: 10.1038/modpathol.2012.94. Epub 2012 Jul 13.
Tumor 'budding', loosely defined by the presence of individual cells and small clusters of tumor cells at the invasive front of carcinomas, has received much recent attention, particularly in the setting of colorectal carcinoma. It has been postulated to represent an epithelial-mesenchymal transition. Tumor budding is a well-established independent adverse prognostic factor in colorectal carcinoma that may allow for stratification of patients into risk categories more meaningful than those defined by TNM staging, and also potentially guide treatment decisions, especially in T1 and T3 N0 (Stage II, Dukes' B) colorectal carcinoma. Unfortunately, its universal acceptance as a reportable factor has been held back by a lack of definitional uniformity with respect to both qualitative and quantitative aspects of tumor budding. The purpose of this review is fourfold: (1) to describe the morphology of tumor budding and its relationship to other potentially important features of the invasive front; (2) to summarize current knowledge regarding the prognostic significance and potential clinical implications of this histomorphological feature; (3) to highlight the challenges posed by a lack of data to allow standardization with respect to the qualitative and quantitative criteria used to define budding; and (4) to present a practical approach to the assessment of tumor budding in everyday practice.
肿瘤“芽生”，通常被定义为在癌的浸润前缘存在单个细胞和小簇肿瘤细胞，近来受到了广泛关注，特别是在结直肠癌中。它被认为代表了上皮-间质转化。肿瘤芽生是结直肠癌中一个明确的独立不良预后因素，它可以将患者分层为比 TNM 分期更有意义的风险类别，也可能为治疗决策提供指导，特别是在 T1 和 T3N0（II 期，Dukes'B）结直肠癌中。不幸的是，由于在肿瘤芽生的定性和定量方面缺乏定义的一致性，其作为一个可报告的因素尚未得到普遍接受。本综述的目的有四：(1)描述肿瘤芽生的形态及其与浸润前缘其他潜在重要特征的关系；(2)总结关于这种组织形态学特征的预后意义和潜在临床意义的现有知识；(3)强调由于缺乏数据，在用于定义芽生的定性和定量标准方面实现标准化所面临的挑战；(4)提出一种在日常实践中评估肿瘤芽生的实用方法。
