The prognostic value of tumor budding in gastric adecarcinomas

Introduction and Aim: Despite advances in diagnosis and treatment modalities, gastric cancer is still the third most common cause of death from malignancies. Tumor budding, which is thought to form a basis for invasion and metastasis lately gains value as a negative prognostic factor in many solid malignancies. In our study, we aimed to evaluate the relationship between the clinicopathological characteristics of the patients and tumor budding, and the effect of budding level on prognosis. Methods: In this retrospective study, excluding patients who were metastatic at the time of diagnosis or histologically diffuse type adenocarcinoma, a total of 104 patients with gastric adenocarcinoma were included. Hematoxylin & Eosin stained slides were evaluated under light microscopy in terms of tumor budding. The patients were divided into two groups according to the budding level as high (≥10 buds) and low (<10 buds). The patients were evaluated in terms of survival and recurrence during their follow-up period and the relation with the level of tumor budding was investigated. Results: 62 of the patients had low level of budding and 42 of them had high level of budding. The mean time from the first diagnosis to the last follow-up was significantly longer (p˂ 0.05) in the low budding level group (27 months) than the high budding level group (17 months). As the T stage, N stage, grade and size of the tumor increased, the proportion of patients with high budding was found significantly higher (p˂ 0.05). Perineural invasion rate was found significantly higher in the high budding level group compared to the low budding level group (p˂ 0.05). In the univariate analysis, a significant effect on survival time of high tumor budding, diagnosis over the age of 60, low BMI, high N stage, presence of lymphovascular invasion and recurrence was observed. In the multivariate analysis with Cox proportional hazards regression, the negative effect of high budding level, age at diagnosis above the age of 60, presence of lymphovascular invasion and recurrence on survival time were observed as independent risk factors predicting mortality. Conclusion: Our study supports that the budding level is a negative prognostic factor in gastric cancer. More comprehensive studies can be a guide in treatment decision and estimating prognosis.