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World J Hepatol. Jun 27, 2023; 15(6): 775-785
Published online Jun 27, 2023. doi: 10.4254/wjh.v15.i6.775
Tumor budding as a potential prognostic marker in determining the behavior of primary liver cancers
Betul Unal, Mennan Yigitcan Celik, Elif Ocak Gedik, Cumhur Ibrahim Bassorgun, Gulsum Ozlem Elpek
Betul Unal, Mennan Yigitcan Celik, Elif Ocak Gedik, Cumhur Ibrahim Bassorgun, Gulsum Ozlem Elpek, Department of Pathology, Akdeniz University Medical School, Antalya 07070, Turkey
Author contributions: Celik MY, Gedik EO, Unal B performed the data acquisition; Bassorgun CI, Unal B and Elpek GO designed the outline and coordinated the writing of the paper; all authors equally contributed to the writing of the paper and preparation of the tables and illustrations.
Conflict-of-interest statement: The authors have no conflicts of interest related to this publication.
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: Gulsum Ozlem Elpek, MD, Professor, Department of Pathology, Akdeniz University Medical School, Dumlupinar Bulvarı, Antalya 07070, Turkey. elpek@akdeniz.edu.tr
Received: February 15, 2023
Peer-review started: February 15, 2023
First decision: March 9, 2023
Revised: March 22, 2023
Accepted: April 18, 2023
Article in press: April 18, 2023
Published online: June 27, 2023
Abstract

Hepatocellular (HCC) and intrahepatic cholangiocarcinoma (ICC), the most common primary tumors of the liver, are among the most important causes of cancer deaths worldwide. Because patients with primary liver tumors are frequently diagnosed at an advanced stage and have high mortality, many efforts have been made to identify new markers to determine their behavior and treatment, similar to those in other solid organ tumors. Recently, morphological assessment of tumor budding (TB) has been revealed as a promising prognostic finding to predict tumor behavior and survival across several different tumor types. Currently, the TB score in colorectal cancer has been revealed as an important parameter in pathology report protocols to determine the course of the disease. Regarding the liver, despite enormous data showing that many mechanisms involved in TB are associated with tumor behavior in both HCC and ICC, studies focusing on the role of TB in predicting the behavior and prognosis of these tumors have started to be investigated very recently. The purpose of this review is to present data about TB in primary tumors of the liver, pointing out the potential role of this parameter in determining the course of the disease, and emphasize the need to increase the number of further studies focusing on the evaluation of this parameter with an overview of the mechanisms involved in TB.

Keywords: Tumor budding, Hepatocellular carcinoma, Cholangiocarcinoma, Prognosis, Liver cancer, Epithelial-mesenchymal transition

Core Tip: This review aims to present recent data on the potential of tumor budding (TB) in determining tumor behavior in hepatocellular carcinoma and cholangiocarcinoma. Although the evidence from the published literature indicates that TB may be a promising prognostic factor for primary liver tumors, more multidisciplinary studies are needed to draw a conclusion. Besides, different assessment techniques in previous investigations indicate that a standard method should be established to provide a solid basis for further studies that may clarify whether this parameter will be included in pathology report protocols as in colorectal carcinoma in the near future.