James Elina, Ravikumar Gayatri, Michael Raj A John, Kulkarni Kiran
Department of Pathology, St. John's Medical College, Bangalore, Karnataka, India.
Department of Biostatistics, St. John's Medical College, Bangalore, Karnataka, India.
Int J Gynecol Pathol. 2025 May 1;44(3):222-229. doi: 10.1097/PGP.0000000000001061. Epub 2024 Jul 29.
Tumor budding (TB) and poorly differentiated clusters (PDCs) are well-established prognostic factors in various cancers. This study aimed to assess the independent prognostic role of these markers in endometrial carcinomas. Retrospective analysis of endometrial carcinoma resection specimens by examining traditional histologic prognostic parameters. TB and PDC were observed at 20× magnification in ten fields at the invasive front and categorized as present or absent. In addition, a count of ≥5 was stratified as "high." Clinical and follow-up details were extracted from Gynecologic Oncology records. Sixty-five endometrial carcinomas were studied and were predominantly endometrioid (n=47, 72.3%). TB was identified in 52.3% of cases, with high TB observed in 38.5%. PDC was evident in 44.6%, with high PDC seen in 29.2%. Associations were significant between the presence of TB/high TB and higher tumor grade ( P < 0.001), deep myometrial invasion ( P = 0.006/ P = 0.002), diffuse pattern of invasion ( P = 0.007/ P = 0.03), microcystic elongated and fragmented pattern ( P < 0.001), lymphovascular space invasion, lymph node metastasis ( P =<0.001) and International Federation of Gynecology and Obstetrics stage ( P = 0.000/ P = 0.002). PDC/high PDC showed similar associations, and, in addition, with nonendometrioid histologic type ( P = 0.02) and tumor location in a lower uterine segment (high PDC, P = 0.009). After adjusting for other significant parameters, both high TB ( P = 0.03) and high PDC ( P = 0.031) emerged as independent prognostic parameters for lymphovascular space invasion or Lymph node metastasis. No recorded deaths or significant events occurred, precluding commentary on overall survival status. High TB and PDC are independent predictors of Lymph node metastasis in endometrial carcinomas. Their association with the microcystic elongated and fragmented pattern makes them histologic predictors of epithelial-mesenchymal transition. Their simple application underscores their potential as valuable additional prognostic indicators for endometrial carcinomas.
肿瘤芽生（TB）和低分化细胞簇（PDCs）是多种癌症中公认的预后因素。本研究旨在评估这些标志物在子宫内膜癌中的独立预后作用。通过检查传统组织学预后参数对子宫内膜癌切除标本进行回顾性分析。在浸润前沿的十个视野中以20倍放大倍数观察TB和PDCs，并分为存在或不存在。此外，计数≥5被分层为“高”。从妇科肿瘤学记录中提取临床和随访细节。研究了65例子宫内膜癌，主要为子宫内膜样癌（n = 47，72.3%）。52.3%的病例中发现了TB，38.5%的病例中观察到高TB。44.6%的病例中PDC明显，29.2%的病例中观察到高PDC。TB/高TB的存在与更高的肿瘤分级（P < 0.001）、肌层深部浸润（P = 0.006/P = 0.002）、弥漫性浸润模式（P = 0.007/P = 0.03）、微囊状拉长和碎片化模式（P < 0.001）、淋巴管间隙浸润、淋巴结转移（P = <0.001）以及国际妇产科联盟分期（P = 0.000/P = 0.002）之间存在显著关联。PDC/高PDC显示出类似的关联，此外，还与非子宫内膜样组织学类型（P = 0.02）和子宫下段肿瘤位置（高PDC，P = 0.009）有关。在调整其他显著参数后，高TB（P = 0.03）和高PDC（P = 该文档中此处有误，应为0.031）均成为淋巴管间隙浸润或淋巴结转移的独立预后参数。没有记录到死亡或重大事件发生，因此无法对总生存状况进行评论。高TB和PDC是子宫内膜癌淋巴结转移的独立预测因素。它们与微囊状拉长和碎片化模式的关联使其成为上皮-间质转化组织学预测指标。它们的简单应用凸显了其作为子宫内膜癌有价值的额外预后指标的潜力。
