Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, 14642, USA.
Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
Hum Pathol. 2021 May;111:75-83. doi: 10.1016/j.humpath.2021.03.004. Epub 2021 Mar 13.
Tumor budding (TB) has been shown to be an adverse prognostic factor in several gastrointestinal malignancies, most notably colorectal carcinoma (CRC). TB has undergone some evaluation in Eastern cohorts of cholangiocarcinoma (CC), and we undertook this study to evaluate whether TB in CC was linked to other clinicopathologic factors or to outcome in a Western cohort. We evaluated 112 cases of CC for age, sex, margin status, location, size, grade, lymphovascular invasion (LVI), perineural invasion (PNI), subtype (large or small duct), staging parameters, recurrence-free survival, disease-specific survival (DSS), and TB. Budding was scored using International Tumor Budding Consensus Conference recommendations for CRC: The highest tumor bud count at the invasive tumor front in a 0.785 mm area was recorded and stratified into Bd1 (0-4 buds), Bd2 (5-9 buds), and Bd3 (≥10 buds). Our cohort included 54 (48%) extrahepatic CCs and 58 (52%) intrahepatic CCs. TB was more commonly seen in the settings of higher-grade lesions, males, extrahepatic CC, PNI, LVI, and positive resection margin (all P ≤ 0.021). In multivariate analysis, worse DSS was correlated with budding score Bd2/Bd3 (hazard ratio [HR] 2.6687, 95% confidence interval [CI] 1.585-5.217, P = 0.001) and with nodal disease (HR 2.876, 95% CI 1.585-5.217, P = 0.001). TB is associated with higher-grade disease in CC, and increased TB is associated with poor disease-specific survival. Our findings support the notion that TB may serve as useful information for clinicians with respect to patient prognosis in CC, as in CRC.
肿瘤出芽（TB）已被证明是几种胃肠道恶性肿瘤的不良预后因素，尤其是结直肠癌（CRC）。TB 在东亚胆管癌（CC）队列中得到了一些评估，我们进行了这项研究，以评估 CC 中的 TB 是否与其他临床病理因素或西方队列中的结果相关。我们评估了 112 例 CC 的年龄、性别、切缘状态、位置、大小、分级、淋巴血管侵犯（LVI）、神经周围侵犯（PNI）、亚型（大或小导管）、分期参数、无复发生存率、疾病特异性生存率（DSS）和 TB。根据结直肠癌国际肿瘤出芽共识会议的建议对肿瘤出芽进行评分：在 0.785 毫米面积的侵袭性肿瘤前缘记录最高的肿瘤芽计数，并分层为 Bd1（0-4 个芽）、Bd2（5-9 个芽）和 Bd3（≥10 个芽）。我们的队列包括 54 例（48%）肝外 CC 和 58 例（52%）肝内 CC。TB 在高级别病变、男性、肝外 CC、PNI、LVI 和阳性切缘的情况下更为常见（所有 P 值均≤0.021）。多变量分析显示，较差的 DSS 与芽评分 Bd2/Bd3（危险比 [HR] 2.6687，95%置信区间 [CI] 1.585-5.217，P=0.001）和淋巴结疾病（HR 2.876，95% CI 1.585-5.217，P=0.001）相关。TB 与 CC 中的高级别疾病相关，TB 增加与疾病特异性生存率差相关。我们的研究结果支持这样一种观点，即 TB 可能像在 CRC 中一样，为 CC 患者的预后提供有用的临床医生信息。
