Goyal Surbhi, Banga Priyanka, Meena Nisha, Chauhan Geeta, Sakhuja Puja, Agarwal Anil Kumar
Pathology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, Delhi, India.
Pathology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, Delhi, India
J Clin Pathol. 2023 May;76(5):308-314. doi: 10.1136/jclinpath-2021-207957. Epub 2021 Dec 1.
The prognostic role of tumour budding (TBd) and its interaction with the stromal microenvironment has gained a lot of attention recently, but remains unexplored in gall bladder cancer (GBC). We aimed to study the interrelationship of TBd by International Tumour Budding Consensus Conference scoring system, tumour-stroma ratio (TSR) and desmoplastic stromal reaction (DSR) with the conventional clinicopathological prognostic factors, mortality and overall survival (OS) in 96 patients of operated GBC.
Higher age, high TNM stage, lymphovascular and perineural invasion, positive resection margins, higher TBd score, low TSR and immature DSR were significantly associated with worse OS. However, on multivariate analysis, only metastases, positive resection margins and TSR <50% proved to be independent prognostic factors. The TBd score of stroma-rich tumour group (6.40±4.69) was significantly higher than that of stroma-poor group (2.77±3.79, p≤0.001). The TBd score of immature and intermediate DSR groups was significantly higher than that of mature group (p≤0.001 and p=0.002, respectively). There was a strong interobserver agreement for TBd score, TSR and type of DSR (Cohen's Kappa=0.726 to 0.864, p≤0.001). Stroma-rich tumours were significantly associated with immature DSR and fibrotic DSR with high TSR (p≤0.001).
A high TBd, low TSR and immature DSR were significantly associated with several high-risk clinicopathological parameters and poor OS in GBC. These novel, simple, reproducible and cost-effective parameters may be included in the routine reporting checklist for GBC as additional prognostic parameters that can substratify the high-risk patients.
肿瘤芽生（TBd）的预后作用及其与基质微环境的相互作用最近受到了广泛关注，但在胆囊癌（GBC）中仍未得到充分研究。我们旨在通过国际肿瘤芽生共识会议评分系统、肿瘤-基质比（TSR）和促纤维增生性基质反应（DSR）研究96例接受手术的GBC患者中TBd与传统临床病理预后因素、死亡率和总生存期（OS）之间的相互关系。
年龄较大、TNM分期较高、淋巴管和神经周围侵犯、手术切缘阳性、TBd评分较高、TSR较低以及DSR不成熟与较差的OS显著相关。然而，多因素分析显示，只有转移、手术切缘阳性和TSR<50%是独立的预后因素。富含基质的肿瘤组的TBd评分（6.40±4.69）显著高于基质贫乏组（2.77±3.79，p≤0.001）。不成熟和中度DSR组的TBd评分显著高于成熟组（分别为p≤0.001和p=0.002）。观察者之间对TBd评分、TSR和DSR类型有很强的一致性（Cohen's Kappa=0.726至0.864，p≤0.001）。富含基质的肿瘤与不成熟的DSR以及高TSR的纤维化DSR显著相关（p≤0.001）。
高TBd、低TSR和不成熟的DSR与GBC的几个高危临床病理参数和较差的OS显著相关。这些新颖、简单、可重复且具有成本效益的参数可纳入GBC的常规报告清单，作为可对高危患者进行分层的额外预后参数。
