Tumour budding and its clinical implications in gastrointestinal cancers

Abstract

Tumour budding in colorectal cancer has become an important prognostic factor. Represented by single cells or small tumour cell clusters at the invasion front of the tumour mass, these tumour buds seem to reflect cells in a ‘hybrid’ state of epithelial–mesenchymal transition, and evidence indicates that the presence of these entities is associated with lymph node metastasis, local recurrence and distant metastatic disease. The International Tumour Budding Consensus Conference (ITBCC) has highlighted a scoring system for the reporting of tumour budding in colorectal cancer, as well as different clinical scenarios that could affect patient management. Other organs are not spared: tumour budding has been described in numerous gastrointestinal and non-gastrointestinal cancers. Here, we give an update on ITBCC validation studies in the context of colorectal cancer and the clinical implications of tumour budding throughout the upper gastrointestinal and pancreatico-biliary tract.

Improving tumor budding reporting in colorectal cancer: a Delphi consensus study

“…With regard to locally resected pT1 cancers, there was strong consensus that TB scoring should be routinely performed in practice, incorporated in national guidelines, and be factored into clinical decision-making. This is supported by strong evidence establishing intermediate and high TB (Bd2/Bd3) as independent predictors of LNM in pT1 CRC [28][29][30]. There was also consensus that locally resected pT1 cancers, in which intermediate or high TB was the only highrisk feature, should be discussed in a multidisciplinary meeting.…”

The prognostic significant of tumor budding, tumor stroma ratio and tumor-infiltrating lymphocytes in gallbladder adenocarcinoma

“…The relationship of high tumor budding score with aggressive tumor characteristics such as more advanced pT, pN and AJCC stages, lymphovascular and perineural invasions, distant metastasis and local tumor recurrence in colorectal cancer has been demonstrated in many studies of the literature. [8,9,[20][21][22][23][24] In the study of Kim et al conducted on 78 GBC patients; a higher TB score was found associated with a poorer histological differentiation, a higher pT stage, presence of LN metastasis as well as lymphatic, venous or perineural tumor invasion. [4] Similarly, Kai et al have also reported that presence of TB was significanly associated with advanced T stage, LN metastasis and venous invasion in GBC.…”

The Importance of Being “That” Colorectal pT1: A Combined Clinico-Pathological Predictive Score to Improve Nodal Risk Stratification

“…Recent evidence also suggested that these features are intertwined and could represent two sides of the same coin, ultimately leading to lymph node metastasis ( 21) since cells composing the tumor "buds" were found to be also responsible for the invasion of nearby stromal lymphovascular vessels. These cells exhibited epithelial and mesenchymal markers suggesting the activation of the epithelialmesenchymal transition process, an aggressive tumor phenotype associated with poor survival and resistance to therapy (37)(38)(39)(40)(41).…”