Tumor Budding and E‐Cadherin Loss as Robust Prognostic Markers in Pancreatic Ductal Adenocarcinoma: A Study in a Turkish Patient Cohort

Objective This study investigates the prognostic significance of tumor budding and its association with E‐cadherin expression in pancreatic ductal adenocarcinoma (PDAC) with a focus on a Turkish patient cohort. Methods A total of 76 patients who had undergone resection of PDAC were analyzed. Tumor budding was assessed according to Tumor Budding Consensus Conference (ITBCC) guideline and classified as low (1–4 buds), medium (5–9 buds), or high (≥ 10 buds). E‐cadherin expression was assessed by immunohistochemistry and categorized as low, moderate, or high. The correlations between tumor budding, clinicopathological factors, and survival were statistically analyzed and examined, and p < 0.05 was considered significant. Results Tumor budding was detected in 42.1% of patients, significantly associated with advanced tumor stage ( p < 0.001), perineural invasion ( p = 0.015), and lymphatic invasion ( p = 0.005). Reduced E‐cadherin expression was strongly correlated with tumor budding, which occurred in 83.3% of patients with weak (+) expression. Kaplan–Meier survival analysis demonstrated a median survival of 7.03 months in patients with tumor budding, compared to 21.7 months in those without tumor budding ( p < 0.001). Multivariate analysis confirmed tumor budding as an independent prognostic factor (HR = 6.594, 95% CI: 1.825–23.818, p = 0.004). Conclusions Tumor budding is a reliable prognostic marker in PDAC, demonstrating significant associations with poor clinical outcomes, including advanced tumor stage and reduced survival. These findings support the integration of tumor budding into clinical guidelines to enhance prognostic precision and guide treatment decision‐making.