Prognostic Role of Tumor-Infiltrating Lymphocytes, Tumor Budding, Tumor Border Configuration, and Tumor Stroma Ratio in Colorectal Carcinoma.

Histomorphological features like tumor-infiltrating lymphocytes (TIL), tumor budding (TB), tumor stroma ratio (TSR), and tumor border configuration (TBC) may provide important prognostic information for more accurate stratification and personalized therapeutic approach in colorectal cancer (CRC). The objective of the current study was to investigate the prognostic impact of novel histopathological features (TIL, TB, TBC, TSR) and a new combined risk score (CRS) in primary CRC. This cross-sectional observational study was conducted on hematoxylin and eosin (H&E)-stained slides of 65 primary CRC cases. Stromal TIL was categorized into 3 groups: low (0 to 10%), intermediate (15 to 50%), and high (55 to 100%). Tumor budding was counted in 10 HPFs and graded as follows: 0-4 buds-low TB, 5-9 buds-intermediate TB, and 10 or more buds-high TB. TBC was labeled as either pushing or infiltrative. TSR was scored into two groups as high TSR (low stroma as ≤ 50%) and low TSR (high stroma > 50%). A novel CRS was constructed based on TBC, TB, and TSR: Infiltrating TBC, TB score > 5 (median), and low TSR were categorized as risk items. Final categories were as follows: low-risk tumors with ≤ 1 risk item and high-risk tumors with > 1 risk items. TIL showed a significant correlation with histological tumor type; TB was significantly associated with tumor location, grade, T stage, and perineural invasion, while TBC significantly correlated with tumor location only. TSR showed significant association with tumor location and perineural invasion, while the combined risk score significantly correlated with tumor location and grade. Tumor border configuration, tumor budding, tumor stroma ratio, and the newly formed combined risk score are simple, cost-effective, potential markers in colorectal cancer patients, suggesting that their incorporation in the routine histopathological evaluation could be useful in determining the prognosis of colorectal cancer cases.