Highlights
- •Tumour budding is not equivalent to tumour grade in colorectal cancer.
- •Both tumour grade and tumour budding are associated with aggressive tumour features.
- •Tumour budding outperforms tumour grade as a prognostic factor.
- •Both contribute different information and should be reported in colorectal cancer.
Abstract
Background
Tumour grade is traditionally considered in the management of patients with colorectal
cancer. However, a large body of literature suggests that a related feature, namely
tumour budding, may have a more important clinical impact. The aim of our study is
to determine the correlation between tumour grade and tumour budding and their impact
on patient outcome.
Methods
A retrospective collective of 771 patients with colorectal cancer were included in
the study. Clinicopathological information included tumour grade (World Health Organisation
2010; G1, G2 and G3) and tumour budding evaluated as BD1, BD2 and BD3 and representing
0–4 buds, 5–9 buds and 10 or more buds per 0.785 mm2, respectively.
Results
Tumour grade and tumour budding were correlated (p < 0.0001, percent concordance:
33.8%). Of the BD1 cases, 18.1% were of G3. Only two BD3 cases were G1. Both high
tumour grade and tumour budding were associated with higher pT, lymph node metastasis,
distant metastasis and lymphatic and venous vessel invasion (p < 0.01, all), but only
tumour grade was additionally associated with right-sided tumour location and mucinous
histology. Higher tumour budding led to worse overall (p = 0.0286) and disease-free
survival (p = 0.001), but tumour grade did not. Budding was independent of tumour
grade in multivariate analysis.
Discussion
Tumour grade and tumour budding are distinct features, as recognised by their different
clinicopathological associations, reflecting different underlying biological processes.
Nonetheless, tumour budding seems to outperform tumour grade in terms of predicting
disease-free survival.
Keywords
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Article info
Publication history
Published online: March 19, 2020
Accepted:
February 8,
2020
Received in revised form:
February 3,
2020
Received:
October 8,
2019
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
