Ran Xin, Chen Yan, Liu Chengxiang, Xiao He, Su Xiaona, Chen Zhuo, Du Jia, He Juan, Zhong Peng, Li Mengxia, Dai Nan, Chen Chuan
Department of Cancer Center, Daping Hospital, Army Medical University, Chongqing, China.
Department of Pathology, Daping Hospital, Army Medical University, Chongqing, China.
J Gastrointest Oncol. 2024 Aug 31;15(4):1545-1555. doi: 10.21037/jgo-24-278. Epub 2024 Aug 26.
Tumor budding (TB) has been shown to be a poor prognostic indicator after colorectal cancer (CRC) surgery. The aim of the present study is to evaluate the predictive role of morphological features (e.g., the number, structure, and location of tumor buds, and their reaction with the extracellular mesenchyme) in postoperative adjuvant chemotherapy in surgically resectable stage II CRC.
Between 2016 and 2019, 336 patients with stage II CRC who underwent radical surgery were enrolled in this study. TB status was determined according to the criteria adopted at the 2016 International Tumor Budding Consensus Conference (ITBCC). We retrospectively recorded all the clinical and pathological data and assessed the effect of different types of TB status on patients' recurrence-free survival (RFS) and overall survival (OS).
Of the 336 patients, 173, 88, and 75 were budding grade 1 (BD1), BD2, and BD3, respectively. The 5-year RFS rates were 84.6%, 81.2%, and 68.0% (P=0.01), and the 5-year OS rates were 91.0%, 83.3%, and 76.2% (P=0.007) in BD1, BD2, and BD3, respectively. TB grade was strongly associated with vascular invasion status and mucinous adenocarcinoma, and BD3 was detected in 51.7% of patients with positive vascular invasion. The multivariate analysis showed that only age, perineural invasion, and TB grade [BD2 BD1, hazard ratio (HR) =1.468, 95% confidence interval (CI): 0.703-3.063, P=0.30; BD3 BD1, HR =2.310, 95% CI: 1.154-4.625, P=0.01] had an independent effect on RFS. In addition, the Kaplan-Meier curve analysis showed that BD3 patients had the worst RFS (P=0.01). The OS of the adjuvant chemotherapy group was significantly improved compared to that of the surgery-only group in the BD1/2 patients (HR =0.278, 95% CI: 0.114-0.676, P=0.005) but not in the BD3 patients with significant interaction (P=0.03).
Our results indicate that TB could play a subsidiary role in selecting stage II CRC patients who could achieve a favorable prognosis with chemotherapy.
肿瘤芽生（TB）已被证明是结直肠癌（CRC）手术后预后不良的指标。本研究的目的是评估形态学特征（例如肿瘤芽的数量、结构和位置，以及它们与细胞外间质的反应）在可手术切除的II期CRC术后辅助化疗中的预测作用。
2016年至2019年期间，336例接受根治性手术的II期CRC患者纳入本研究。根据2016年国际肿瘤芽生共识会议（ITBCC）采用的标准确定TB状态。我们回顾性记录了所有临床和病理数据，并评估了不同类型的TB状态对患者无复发生存期（RFS）和总生存期（OS）的影响。
336例患者中，分别有173例、88例和75例为芽生1级（BD1）、BD2和BD3级。BD1、BD2和BD3级的5年RFS率分别为84.6%、81.2%和68.0%（P=0.01），5年OS率分别为91.0%、83.3%和76.2%（P=0.007）。TB分级与血管侵犯状态和黏液腺癌密切相关，51.7%的血管侵犯阳性患者检测到BD3级。多因素分析显示，只有年龄、神经周围侵犯和TB分级[BD2对比BD1，风险比（HR）=1.468，95%置信区间（CI）：0.703-3.063，P=0.30；BD3对比BD1，HR =2.310，95%CI：1.154-4.625，P=0.01]对RFS有独立影响。此外，Kaplan-Meier曲线分析显示BD3级患者的RFS最差（P=0.01）。在BD1/2级患者中，辅助化疗组的OS与单纯手术组相比有显著改善（HR =0.278，95%CI：0.114-0.676，P=0.005），但在有显著交互作用的BD3级患者中没有改善（P=0.03）。
我们的结果表明，TB在选择可通过化疗获得良好预后的II期CRC患者中可能起辅助作用。
