Zlobec Inti, Borner Markus, Lugli Alessandro, Inderbitzin Daniel
Institute of Pathology, University of Bern, Murtenstrasse 31, 3010 Bern, Switzerland.
Int J Surg Oncol. 2012;2012:795945. doi: 10.1155/2012/795945. Epub 2012 Jul 31.
The presence of tumor budding (TuB) at the invasive front of rectal cancers is a valuable indicator of tumor aggressiveness. Tumor buds, typically identified as single cells or small tumor cell clusters detached from the main tumor body, are characterized by loss of cell adhesion, increased migratory, and invasion potential and have been referred to as malignant stem cells. The adverse clinical outcome of patients with a high-grade TuB phenotype has consistently been demonstrated. TuB is a category IIB prognostic factor; it has yet to be investigated in the prospective setting. The value of TuB in oncological and pathological practice goes beyond its use as a simple histomorphological marker of tumor aggressiveness. In this paper, we outline three situations in which the assessment of TuB may have direct implications on treatment within the multidisciplinary management of patients with rectal cancer: (a) patients with TNM stage II (i.e., T3/T4, N0) disease potentially benefitting from adjuvant therapy, (b) patients with early submucosally invasive (T1, sm1-sm3) carcinomas at a high risk of nodal positivity and (c) the role of intratumoral budding assessed in preoperative biopsies as a marker for lymph node and distant metastasis thus potentially aiding the identification of patients suitable for neoadjuvant therapy.
肿瘤芽生（TuB）出现在直肠癌浸润前沿是肿瘤侵袭性的一个重要指标。肿瘤芽通常被识别为从主要肿瘤主体脱离的单个细胞或小肿瘤细胞簇，其特征是细胞黏附丧失、迁移和侵袭潜能增加，被称为恶性干细胞。高级别TuB表型患者的不良临床结局已得到一致证实。TuB是IIB类预后因素；尚未在前瞻性研究中进行调查。TuB在肿瘤学和病理学实践中的价值不仅限于作为肿瘤侵袭性的简单组织形态学标志物。在本文中，我们概述了三种情况，其中TuB评估可能对直肠癌患者多学科管理中的治疗有直接影响：（a）TNM II期（即T3/T4，N0）疾病患者可能从辅助治疗中获益；（b）早期黏膜下浸润（T1，sm1-sm3）癌且淋巴结阳性风险高的患者；（c）术前活检中评估的瘤内芽生作为淋巴结和远处转移标志物的作用，从而可能有助于识别适合新辅助治疗的患者。
