Histopathological Significance and Prognostic Impact of Tumor Budding in Colorectal Cancer.

Background: Colorectal cancer (CRC) is a heterogeneous disease with a complex etiology. New prognostic factors need to be investigated. Our present focus is on histopathological significance and prognostic impact of tumor budding in CRC. Material and Methods: A total of 60 treatment-naive consecutive patients undergoing surgical resection of CRCs during the period of January 2011 to December 2013 were included in the study. Details of each related to their demographic and tumor profile were recorded. Hematoxylin and Eosin (H and E) and pan-cytokeratin details of each “case” immunohistochemically stained sections were examined for tumor budding assessment along with clinical features. Results: The most frequent site of involvement was the rectosigmoid and sigmoid colon (31.6%). The majority of the cases were moderately differentiated (75%), showed tumor invasion into the pericolic/subserosal fat (66.6%) and stage III (38.3%). Nodal involvement was present in 47%. Correlations between tumor budding and nodal involvement (p-value 0.039) and AJCC stage (p-value 0.021) were found to be statistically significant. Conclusion: Tumor budding is a promising and powerful predictor of lymph nodal metastasis and a higher stage of tumor and can be used as a marker for high-risk CRC. Routine H and E staining aided by cytokeratin immunostaining allows reproducible grading of tumor budding in CRC cases.