Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2024; 30(2): 158-169
Published online Jan 14, 2024. doi: 10.3748/wjg.v30.i2.158
Association of tumor budding with clinicopathological features and prognostic value in stage III-IV colorectal cancer
Yue-Hao Luo, Zhe-Cheng Yan, Jia-Ying Liu, Xin-Yi Li, Ming Yang, Jun Fan, Bo Huang, Cheng-Gong Ma, Xiao-Na Chang, Xiu Nie
Yue-Hao Luo, Zhe-Cheng Yan, Jia-Ying Liu, Xin-Yi Li, Ming Yang, Jun Fan, Bo Huang, Cheng-Gong Ma, Xiao-Na Chang, Xiu Nie, Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
Co-first authors: Yue-Hao Luo and Zhe-Cheng Yan.
Co-corresponding authors: Xiao-Na Chang and Xiu Nie.
Author contributions: Luo YH and Yan ZC contributed equally to this work; Luo YH, Yan ZC, Liu JY, Li XY, Yang M, and Fan J designed the research study; Luo YH, Huang B, and Ma CG performed the research; Luo YH, Chang XN, and Niu X analyzed the data and wrote the manuscript; All authors have read and approve the final manuscript.
Supported by National Key R&D Program of China, No. 2022YFF1203300.
Institutional review board statement: This study was approved by the review committee of the affiliated institution of Tongji Medical College of Huazhong University of Science and Technology (2018-S377).
Informed consent statement: Consent was obtained from all patients participating in the study.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiu Nie, MD, Professor, Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, China. niexiuyishi@126.com
Received: October 25, 2023
Peer-review started: October 25, 2023
First decision: November 12, 2023
Revised: November 23, 2023
Accepted: December 14, 2023
Article in press: December 14, 2023
Published online: January 14, 2024
Processing time: 78 Days and 15.4 Hours
ARTICLE HIGHLIGHTS
Research background

Tumor budding (TB) is a novel prognostic biomarker that may influence clinical treatment decisions in stage I-II colorectal cancer (CRC) patients. This study analyzed the relationship between TB categories and clinicopathological characteristics and assess their prognostic value in stage III-IV CRC to further refine the prognostic risk stratification of stage III-IV CRC. Additionally, we analyzed changes in tumor-infiltrating lymphocytes (TILs) in patients with different TB categories and initially explored the correlation between TB and the tumor immune microenvironment.

Research motivation

To explore the association of TB with clinicopathological features and prognostic value in stage III-IV CRC.

Research objectives

This study analyzed the relationship between TB categories and clinicopathological characteristics and assess their prognostic value in stage III-IV CRC to further refine the prognostic risk stratification of stage III-IV CRC.

Research methods

This study included a substantial number of 547 CRC patients. TB was evaluated independently by two pathologists and re-evaluated by a third pathologist when the results were inconsistent, ensuring a high level of reliability in the TB assessment. Furthermore, the 2016 International TB Consensus Conference recommendations were followed to evaluate TB specifically in patients with stage III-IV CRC, thereby investigating its impact on patient prognosis.

Research results

Multivariate Cox proportional hazards regression analysis demonstrated that chemotherapy, clinical stage IV, ≥ 4 regional lymph node metastases, left-sided colonic cancer, and Bd 2-3 were independent prognostic factors in patients with stage III-IV CRC. Moreover, the density of TILs was higher in Bd 1 than in Bd 2-3, both in the tumor stroma and its invasive margin.

Research conclusions

TB has an independent predictive prognostic value for progression-free survival and overall survival in patients with stage III-IV CRC. It is recommended to complete the TB report of stage III-IV CRC cases in the standardized pathological report to further refine risk stratification.

Research perspectives

A multicenter prospective study with large samples should be conducted in the future, and constructing a prognosis model with a multi-index multidimensional association algorithm with other prediction models is needed to further verify its reliability.