Zhang Wenwen, Song Yiling, Shi Haiyan, Lu Bingjian
Department of Surgical Pathology, Womens Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
Department of Surgical Pathology, Huzhou Maternity and Child Health Care Hospital, Huzhou, China.
Histopathology. 2025 May;86(6):967-978. doi: 10.1111/his.15404. Epub 2024 Dec 27.
Our study aimed to further confirm the clinical significance of the tumour budding activity and cell nest size-based (TBNS) grading scheme in cervical squamous cell carcinomas (SCC).
We applied the TBNS system to assess the prognostic value in an institutional cohort of well-annotated cervical SCC consisting of 312 consecutive cases with surgical resection, no neoadjuvant chemotherapy and higher than stage pT1a. We found that high budding activity, single cell and TBNS grade 3 were more frequently associated with a decreased overall survival (OS) time and disease-free survival (DFS) time (P < 0.001) and several other clinicopathological factors, including lymphovascular space invasion, lymph node metastasis, advanced Federation of Gynecology and Obstetrics (FIGO) stage and deep invasion of the cervical wall (> 2/3) (P < 0.05). On multivariate analysis, TBNS grade 3 was an adverse indicator for OS and DFS independently of age, invasion of the cervical wall and FIGO stage (P < 0.05). By comparison, the conventional three-tiered grading system was not associated with OS and DFS in cervical SCC (P > 0.05).
Our study further confirms that the TBNS grading scheme is robust in prognostic assessment in cervical SCC that outperforms the conventional three-tiered grading system. It is applicable to add TBNS grade into routine diagnostic practice.
我们的研究旨在进一步证实肿瘤芽生活性和基于细胞巢大小（TBNS）的分级方案在宫颈鳞状细胞癌（SCC）中的临床意义。
我们应用TBNS系统对一组机构队列中注释完善的宫颈SCC患者进行预后评估，该队列由312例连续接受手术切除、未接受新辅助化疗且分期高于pT1a的病例组成。我们发现高芽生活性、单细胞及TBNS 3级更常与总生存期（OS）时间和无病生存期（DFS）时间缩短相关（P < 0.001），还与其他几个临床病理因素相关，包括脉管间隙浸润、淋巴结转移、国际妇产科联盟（FIGO）晚期及宫颈壁深层浸润（> 2/3）（P < 0.05）。多因素分析显示，TBNS 3级是OS和DFS的不良指标，独立于年龄、宫颈壁浸润及FIGO分期（P < 0.05）。相比之下，传统的三级分级系统与宫颈SCC的OS和DFS无关（P > 0.05）。
我们的研究进一步证实，TBNS分级方案在宫颈SCC的预后评估中表现稳健，优于传统的三级分级系统。它适用于将TBNS分级纳入常规诊断实践。
