Yavuz A, Simsek K, Alpsoy A, Altunay B, Gedik EO, Unal B, Bassorgun CI, Tatli AM, Elpek GO. Prognostic significance of tumor budding, desmoplastic reaction, and lymphocytic infiltration in patients with gastric adenocarcinoma. World J Gastrointest Pathophysiol 2024; 15(1): 91237 [PMID: 38682027 DOI: 10.4291/wjgp.v15.i1.91237]
Corresponding Author of This Article
Gulsum Ozlem Elpek, MD, Professor, Department of Pathology, Akdeniz University Medical School, Dumlupinar Bulvarı, Antalya 07070, Türkiye. elpek@akdeniz.edu.tr
Research Domain of This Article
Pathology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Pathophysiol. Apr 22, 2024; 15(1): 91237 Published online Apr 22, 2024. doi: 10.4291/wjgp.v15.i1.91237
Prognostic significance of tumor budding, desmoplastic reaction, and lymphocytic infiltration in patients with gastric adenocarcinoma
Aysen Yavuz, Kubra Simsek, Anil Alpsoy, Busra Altunay, Elif Ocak Gedik, Betul Unal, Cumhur Ibrahim Bassorgun, Ali Murat Tatli, Gulsum Ozlem Elpek
Aysen Yavuz, Kubra Simsek, Anil Alpsoy, Busra Altunay, Elif Ocak Gedik, Betul Unal, Cumhur Ibrahim Bassorgun, Gulsum Ozlem Elpek, Department of Pathology, Akdeniz University Medical School, Antalya 07070, Türkiye
Ali Murat Tatli, Department of Medical Oncology, Akdeniz University Medical School, Antalya 07070, Türkiye
Author contributions: Yavuz A and Elpek GOE designed and performed the research and wrote the paper; Simsek K, Alpsoy A, Altunay B, Gedik EO, Unal B, and Bassorgun CI are involved in the data curation, investigation, and resources; Tatli AM provided clinical advice; and all authors equally contributed to the analysis of the data.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the Akdeniz University (Approval No. 13.12.2023/915).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data obtained after each patient agreed to treatment by written permission. One of these forms is presented below.
Conflict-of-interest statement: There is no conflict of interest.
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: Gulsum Ozlem Elpek, MD, Professor, Department of Pathology, Akdeniz University Medical School, Dumlupinar Bulvarı, Antalya 07070, Türkiye. elpek@akdeniz.edu.tr
Received: December 25, 2023 Peer-review started: December 25, 2023 First decision: February 24, 2024 Revised: March 8, 2024 Accepted: March 22, 2024 Article in press: March 22, 2024 Published online: April 22, 2024
Abstract
BACKGROUND
Recent studies have shown that the tumor microenvironment significantly influences the behavior of solid tumors. In this context, Accumulated data suggests that pathological evaluation of tumor budding (TB), desmoplastic reaction (DR), and tumor-infiltrating lymphocytes (TILs) may be crucial in determining tumor behavior in the gastrointestinal tract. Regarding gastric adenocarcinoma (GAC), although some results suggest that TB and TILs may be effective in determining the course of the disease, the data do not agree. Moreover, very few studies have investigated the relationship between DR and survival. At present, the associations between tumor TB, DR and TILs in GAC patients have not been determined.
AIM
To establish the relationships between TB, DR, and TILs in patients with GAC and to assess their influence on prognosis.
METHODS
Our study group comprised 130 patients diagnosed with GAC. The definition of TB was established based on the International TB Consensus Conference. The DR was categorized into three groups according to the level of tumor stroma maturation. The assessment of TILs was conducted using a semiquantitative approach, employing a cutoff value of 5%. The statistical analysis of the whole group and 100 patients with an intestinal subtype of GAC was performed using SPSS version 27.
RESULTS
A significant correlation between peritumoral budding (PTB) and intratumoral budding (ITB) was noted (r = 0.943). Tumors with high PTBs and ITBs had a greater incidence of immature DRs and low TILs (P < 0.01). PTB and ITB were associated with histological subtype, lymph node metastasis (LNM), and stage (P < 0.01). ITB, PTB, LNM, DR, and stage were significant risk factors associated with poor prognosis. The multivariate Cox regression analysis identified ITB, PTB, and LNM as independent prognostic variables (P < 0.05). In intestinal-type adenocarcinomas, a positive correlation between PTB and ITB was noted (r = 0.972). While univariate analysis revealed that LNM, stage, PTB, ITB, and DR were strong parameters for predicting survival (P < 0.05), only PTB and ITB were found to be independent prognostic factors (P < 0.001).
CONCLUSION
TB may be a potential prognostic marker in GAC. However, further studies are needed to delineate its role in pathology reporting protocols and the predictive effects of DR and TILs.
Core Tip: This study investigated the relationships between tumor budding, desmoplastic reaction (DR), and tumor-infiltrating lymphocytes (TILs) in patients with gastric adenocarcinomas (GAC) and assessed their influence on prognosis. Our results demonstrated that TB is a promising prognostic factor in GAC. While it could also be valuable in determining survival in patients with unresectable tumors, further studies are needed to draw a conclusion. Although the DR and TILs were not observed as independent parameters, their close association with TB in patients with GAC suggests their value in predicting tumor behavior merits further research to clarify their roles better.
