Review Article

Role of Intra- and Peritumoral Budding in the Interdisciplinary Management of Rectal Cancer Patients

Table 1

Summary of studies evaluating tumor budding in submucosally invasive (T1) colorectal carcinomas.

Ref.Number of patientsEndpointSummary of relevant findings

[20]499LN+8.2% of T1 were LN+. Several features were independent predictors of LN+: tumor differentiation/mucinous histology, depth of submucosal invasion, venous invasion, and TuB.
[6]111LN+TuB was associated with LN+ in univariate but not multivariate analysis when analysed with protein markers.
[21]32DMIn comparison to a control group, TuB was more frequent in patients who eventually had a distant metastasis in univariate but not multivariate analysis.
[22]111LN+Several features were evaluated including lymphatic and venous invasion, submucosal depth, histologic type, and TuB. In multivariate analysis, only histologic type and TuB predicted LN+.
[23]65LN+T1-T2 rectal cancers. 6.9% of T1 were LN+. TuB predicted lateral LN+.
[24]322LN+14.3% of T1 were LN+. Several features predicted LN+: invasion depth, lymphatic and venous invasion, tumor differentiation, growth pattern, and TuB. Only lymphatic invasion, differentiation, and TuB were independent predictors in multivariate analysis.
[25]124LN+ and DMElastica von Gieson, D2-40, and CAM5 were used to enhance visualization of venous invasion, lymphatic invasion, and TuB, respectively. TuB was an independent predictor of LN+ and DM+ in multivariate analysis.
[26]87LN+ and LRProspective study evaluating two groups of patients after endoscopic resection: a surgical group and a follow-up group without surgery. TuB was the only independent predictor of LN+ in multivariate analysis.
[27]164LN+9.8% of T1 were LN+. TuB was significantly associated with LN+ in univariate and multivariate analysis.
[28]71LN+Tumor size, depth of invasion, histologic type, TuB, and lymphatic invasion were predictors in univariate analysis but only TuB and lymphatic invasion were significant in multivariate analysis.
[29]86LN+13% of T1 were LN+. Vascular invasion, tumor budding, and degree of submucosal invasion could be combined to strongly predict LN+.
[30] 214LN+Several histopathological and protein markers were evaluated. TuB was a significant predictor in univariate and multivariate analysis.
[31]76LN+TuB can be used in a predictive equation for LN+.
[32]56LN+TuB evaluated using CAM5 was significantly more frequent in LN+ (16/42) than LN negative (0/14) cases.
[16]159LN+, OS10.1% of T1 were LN+ and were associated with several features including TuB. TuB did not influence overall survival.
[33]51LN+, LRTuB was associated to lymphatic invasion, LN+, and local relapse.
[34]79LN+13.9% were LN+. TuB was one of five risk factors for LN+.

TuB: tumor budding; LN: lymph node; DM: distant metastasis; LR: local recurrence; OS: overall survival.