Abstract Background and Objectives: Tumor budding (TB) is defined as single tumor cells or isolated clusters of up to 4 tumor cells at the invasive front of tumor. TB has been proven as a remarkably consistent predictor of adverse outcome in colorectal carcinoma (CRC). In this study, we aimed to assess the pattern of TB score in CRC patients and to investigate the association of known histopathological prognostic factors with TB and pathological tumor, node, and metastasis (TNM) staging. Materials and Methods: This was a retrospective cross-sectional study conducted on CRC patients over a 1-year study period who underwent surgical resection having residual disease on pathological examination. The resected specimens were grossed and reported as per the College of American Pathologist (CAP) protocol 2021. TB scoring was performed according to the International Tumor Budding Consensus Conference 2016 format and was graded according to the three-tier system with scores of 0–4 indicating low-grade, 5–9 indicating intermediate-grade, and ≥10 indicating high-grade budding. The association between TB score and other clinic-histopathological parameters was analyzed. One hundred and nine patients underwent surgery during the study period (upfront surgery: n = 69; and neoadjuvant treatment followed by surgery: n = 40). Six of 40 patients receiving neoadjuvant treatment had no residual disease on histopathological examination of postoperative specimen and were excluded from TB scoring. Results: A total of 103 CRC patients with a mean age of 58.42 ± 12.48 years were analyzed. The high TB score was associated with higher TNM stage ( P = 0.0003), nodal involvement ( P = 0.0003), and lymphovascular invasion ( P = 0.0010). There is a trend of more microsatellite instability-high detection in patients with high TB score ( P = 0.09). No significant association was found between TB score and perineural invasion (PNI; P = 0.29). A high TB score was associated with a higher pathological TNM stage. Higher TNM stage predicts an adverse disease outcome. There was no correlation between TB score and age, gender, and PNI. Conclusion: We concluded that TB score is an important prognostic and predictive parameter showing its clinical impact and translational relevance in the management of patients with CRC.
Tamhane et al. (Wed,) studied this question.