1
|
Wu G, Luo R, Xu Q, Yang L, Xia H, Chew V, Koh YX, Chang KTE, Zhou J, Fan J, Gao Q, Shi R, Zhu K. Tumor budding in pre-neoadjuvant biopsy and post-neoadjuvant resection specimens is associated with poor prognosis in intrahepatic cholangiocarcinoma-a cohort study of 147 cases by modified ITBCC criteria. Virchows Arch 2024:10.1007/s00428-024-03937-y. [PMID: 39384623 DOI: 10.1007/s00428-024-03937-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/30/2024] [Accepted: 09/29/2024] [Indexed: 10/11/2024]
Abstract
Tumor budding (TB) has been associated with poor survival in a variety of cancers including intrahepatic cholangiocarcinoma (iCCA). As tumor histomorphological features are significantly altered after neoadjuvant therapy (NAT), our study aims to assess the prognostic significance of TB in iCCA patients before and after NAT, by the modified International Tumor Budding Consensus Conference (ITBCC) criteria. 147 NAT-treated iCCA cases were included in this study. In biopsy specimens obtained before NAT, the TB-positive subgroup had lower overall survival (OS) in univariate analysis (P = 0.010). In resection specimens obtained after NAT, the TB-positive subgroup had reduced OS (P = 0.002) and recurrence-free survival (RFS) (P = 0.013) in univariate analysis. In multivariate analysis including TNM stage, lymphovascular invasion and perineural invasion, TB-positive in post-NAT resection was also found as an independent prognostic factor for both OS and RFS (OS, HR, 3.005; 95% CI, 1.333-6.775, P = 0.008; RFS, HR, 1.748; 95% CI, 1.085-2.816, P = 0.022). In conclusion, assessing the presence of TB by modified ITBCC criteria provides robust prognostic information in the NAT setting of iCCA patients and can be considered to be included in routine pathological reporting.
Collapse
Affiliation(s)
- Gaohua Wu
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, P.R. China, 20032
| | - Rongkui Luo
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qianhui Xu
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, P.R. China, 20032
| | - Liuxiao Yang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, P.R. China, 20032
| | - Hongping Xia
- Zhongda Hospital, School of Medicine & Advanced Institute for Life and Health, Southeast University, Nanjing, China
| | - Valerie Chew
- SingHealth-DukeNUS Academic Medical Centre, Translational Immunology Institute (TII), Singapore, Singapore
| | - Ye Xin Koh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore
| | - Kenneth Tou En Chang
- Department of Pathology and Laboratory Medicine, Kandang Kerbau Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Jian Zhou
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, P.R. China, 20032
| | - Jia Fan
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, P.R. China, 20032
| | - Qiang Gao
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, P.R. China, 20032.
| | - Ruoyu Shi
- Department of Pathology and Laboratory Medicine, Kandang Kerbau Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
| | - Kai Zhu
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, P.R. China, 20032.
| |
Collapse
|
2
|
Kaminuma Y, Nakai T, Aokage K, Taki T, Miyoshi T, Tane K, Samejima J, Miyazaki S, Sakamoto N, Sakashita S, Kojima M, Watanabe R, Tsuboi M, Ishii G. Prognostic significance of micronest in cancer stroma in resected lung squamous cell carcinoma. Hum Pathol 2024; 150:20-28. [PMID: 38914166 DOI: 10.1016/j.humpath.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 06/26/2024]
Abstract
Tumor budding in the cancer stroma has been reported to be a prognostic factor in non-small cell lung cancer. Micronest in cancer stroma (MICS) is often observed as a formation that is larger and more conspicuous than budding, but its clinicopathologic significance is unclear. In this study, we aimed to examine the clinicopathological significance of MICS in lung squamous cell carcinoma (LSqCC). A total of 198 consecutive patients with pathologically diagnosed LSqCC (anyT N0-1M0) were enrolled in this study. MICS were defined as those that met the following criteria: (1) consisting of 5-200 tumor cells or less than 200 μm in diameter and (2) more than 200 μm away from the adjacent main lesion. The prognostic impact of the presence or absence of MICS and the characteristics of MICS-forming cancer cells were evaluated by immunohistochemistry (IHC). MICS was observed in 57 patients (28.8%), and overall survival (OS) and recurrence-free survival (RFS) were significantly shorter in the MICS-positive group (OS: 44.4% vs. 84.4%, p < 0.001; RFS: 30.0% vs. 82.6%, p < 0.001). Univariate and multivariate analyses revealed that the presence of MICS was an independent poor prognostic factor for OS (hazard ratio [HR] 3.54, p < 0.001) and RFS (HR 4.99, p < 0.001). Immunohistochemistry showed that the expression levels of the cell-cell adhesion molecule E-cadherin and hypoxia-induced protein GLUT-1 were significantly decreased in cancer cells forming MICS lesions compared to the tumor component excluding MICS within the same tumor (non-MICS lesions). Our data show that MICS is a distinct morphological feature with important biological and prognostic significance.
Collapse
Affiliation(s)
- Yasunori Kaminuma
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan; Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan; Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Tokiko Nakai
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
| | - Keiju Aokage
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
| | - Tetsuro Taki
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
| | - Tomohiro Miyoshi
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
| | - Kenta Tane
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
| | - Joji Samejima
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
| | - Saori Miyazaki
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
| | - Naoya Sakamoto
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan; Division of Pathology, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Chiba, Japan.
| | - Shingo Sakashita
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan; Division of Pathology, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Chiba, Japan.
| | - Motohiro Kojima
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan; Division of Pathology, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Chiba, Japan.
| | - Reiko Watanabe
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
| | - Masahiro Tsuboi
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
| | - Genichiro Ishii
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan; Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan; Division of Innovative Pathology and Laboratory Medicine, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Chiba, Japan.
| |
Collapse
|
3
|
Maillard M, Neppl C, Zens P, Anex J, Peters S, Krueger T, Berezowska S. Multicenter Study on Tumor Budding in Lung Squamous Cell Carcinoma: Comparison Between Biopsy and Resection With Interobserver Variability Assessment. Mod Pathol 2024; 37:100571. [PMID: 39038789 DOI: 10.1016/j.modpat.2024.100571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 07/01/2024] [Accepted: 07/14/2024] [Indexed: 07/24/2024]
Abstract
Grading lung squamous cell carcinoma (LUSC) is controversial and not universally accepted. The histomorphologic feature of tumor budding (TB) is an established independent prognostic factor in colorectal cancer, and its importance is growing in other solid cancers, making it a candidate for inclusion in tumor grading schemes. We aimed to compare TB between preoperative biopsies and resection specimens in pulmonary squamous cell carcinoma and assess interobserver variability. A retrospective cohort of 249 consecutive patients primarily resected with LUSC in Bern (2000-2013, n = 136) and Lausanne (2005-2020, n = 113) with available preoperative biopsies was analyzed for TB and additional histomorphologic parameters, such as spread through airspaces and desmoplasia, by 2 expert pathologists (M.M., C.N.). Results were correlated with clinicopathologic parameters and survival. In resection specimens, peritumoral budding (PTB) score was low (0-4 buds/0.785 mm2) in 47.6%, intermediate (5-9 buds/0.785 mm2) in 27.4%, and high (≥10 buds/0.785 mm2) in 25% of cases (median bud count, 5; IQR, 0-26). Both the absolute number of buds and TB score were similar when comparing tumor edge and intratumoral zone (P = .192) but significantly different from the score obtained in the biopsy (P < .001). Interobserver variability was moderate, regardless of score location (Cohen kappa, 0.59). The discrepant cases were reassessed, and consensus was reached in all cases with identification of causes of discordance. TB score was significantly associated with stage (P = .002), presence of lymph node (P = .033), and distant metastases (P = .020), without significant correlation with overall survival, tumor size, or pleural invasion. Desmoplasia was significantly associated with higher PTB (P < .001). Spread through airspaces was present in 34% and associated with lower PTB (P < .001). To conclude, despite confirming TB as a reproducible factor in LUSC, we disclose areas of scoring ambiguity. Preoperative biopsy evaluation was insufficient in establishing the final TB score of the resected tumor.
Collapse
Affiliation(s)
- Marie Maillard
- Institute of Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Christina Neppl
- Institute of Pathology, Heinrich-Heine University and University Hospital of Duesseldorf, Germany; Institute of Tissue Medicine and Pathology, University of Bern, Bern, Switzerland
| | - Philipp Zens
- Institute of Tissue Medicine and Pathology, University of Bern, Bern, Switzerland; Graduate School for Health Science, University of Bern, Bern, Switzerland
| | - Julie Anex
- Institute of Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Solange Peters
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thorsten Krueger
- Department of Thoracic Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sabina Berezowska
- Institute of Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| |
Collapse
|
4
|
Liu H, Lan T, Cai YS, Lyu YH, Zhu J, Xie SN, Hu FJ, Liu C, Wu H. Predicting prognosis in intrahepatic cholangiocarcinoma by the histopathological features. Asian J Surg 2024; 47:2589-2597. [PMID: 38604849 DOI: 10.1016/j.asjsur.2024.03.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/23/2023] [Accepted: 03/06/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Intrahepatic cholangiocarcinoma (ICC) is a highly heterogeneous liver tumor. The associations between histopathological feature and prognosis of ICC are limited. The present study aimed to investigate the prognostic significance of glandular structure and tumor budding in ICC. METHODS Patients received radical hepatectomy for ICC were included. Glandular structure and tumor budding were detected by Hematoxylin-eosin staining. The Kaplan-Meier method and the Cox proportional hazards regression model were used to calculate the survival and hazard ratio. Based on the results of multivariate analysis, nomograms of OS and DFS were constructed. C-index and Akaike information criterion (AIC) were used to assess accuracy of models. RESULTS A total of 323 ICC patients who underwent surgery were included in our study. Glandular structure was associated with worse overall survival (OS) [hazard ratio (HR): 2.033, 95% confidence interval (CI): 1.047 to 3.945] and disease-free survival (DFS) [HR: 1.854, 95% CI: 1.082 to 3.176]. High tumor budding was associated with worse DFS [HR: 1.636, 95%CI: 1.060 to 2.525]. Multivariate analysis suggested that glandular structure, tumor number, lymph node metastasis, and CA19-9 were independent risk factors for OS. Independent predictor factors for DFS were tumor budding, glandular structure, tumor number, and lymph node metastasis. The c-index (0.641 and 0.642) and AIC (957.69 and 1188.52) showed that nomograms of OS and DFS have good accuracy. CONCLUSION High tumor budding and glandular structure are two important histopathological features that serve as prognostic factors for ICC patients undergoing hepatectomy.
Collapse
Affiliation(s)
- Hu Liu
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China; Liver Transplant Center, Transplant Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Tian Lan
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China; Liver Transplant Center, Transplant Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yun-Shi Cai
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China; Liver Transplant Center, Transplant Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ying-Hao Lyu
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China; Liver Transplant Center, Transplant Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jiang Zhu
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China; Liver Transplant Center, Transplant Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Si-Nan Xie
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China; Liver Transplant Center, Transplant Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Feng-Juan Hu
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Chang Liu
- Division of Liver, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China; Department of Minimal Invasive Surgery, Shangjin Nanfu Hospital, Chengdu, 610037, China.
| | - Hong Wu
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China; Liver Transplant Center, Transplant Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
| |
Collapse
|
5
|
Berezowska S, Maillard M, Keyter M, Bisig B. Pulmonary squamous cell carcinoma and lymphoepithelial carcinoma - morphology, molecular characteristics and differential diagnosis. Histopathology 2024; 84:32-49. [PMID: 37936498 DOI: 10.1111/his.15076] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/25/2023] [Accepted: 10/04/2023] [Indexed: 11/09/2023]
Abstract
Squamous cell carcinoma (SCC) comprises one of the major groups of non-small-cell carcinoma of the lung, and is subtyped into keratinising, non-keratinising and basaloid SCC. SCC can readily be diagnosed using histomorphology alone in keratinising SCC. Confirmatory immunohistochemical analyses should always be applied in non-keratinising and basaloid tumours to exclude differential diagnoses, most prominently adenocarcinoma and high-grade neuroendocrine carcinoma, which may have important therapeutic consequences. According to the World Health Organisation (WHO) classification 2015, the diagnosis of SCC can be rendered in resections of morphologically ambiguous tumours with squamous immunophenotype. In biopsies and cytology preparations in the same setting the current guidelines propose a diagnosis of 'non-small-cell carcinoma, favour SCC' in TTF1-negative and p40-positive tumours to acknowledge a possible sampling bias and restrict extended immunohistochemical evaluation in order to preserve tissue for molecular testing. Most SCC feature a molecular 'tobacco-smoke signature' with enrichment in GG > TT mutations, in line with the strong epidemiological association of SCC with smoking. Targetable mutations are extremely rare but they do occur, in particular in younger and non- or light-smoking patients, warranting molecular investigations. Lymphoepithelial carcinoma (LEC) is a poorly differentiated SCC with a syncytial growth pattern and a usually prominent lymphoplasmacytic infiltrate and frequent Epstein-Barr virus (EBV) association. In this review, we describe the morphological and molecular characteristics of SCC and LEC and discuss the most pertinent differential diagnoses.
Collapse
Affiliation(s)
- Sabina Berezowska
- Department of Laboratory Medicine and Pathology, Institute of Pathology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Marie Maillard
- Department of Laboratory Medicine and Pathology, Institute of Pathology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Mark Keyter
- Department of Laboratory Medicine and Pathology, Institute of Pathology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Bettina Bisig
- Department of Laboratory Medicine and Pathology, Institute of Pathology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
6
|
Ciflik KB, Dogan HT, Dogan E, Ciflik BO, Kocer B, Karaoglanoglu N, Yekeler E. Can tumour budding change the future of pulmonary adenocarcinoma? Pathol Res Pract 2023; 250:154808. [PMID: 37748210 DOI: 10.1016/j.prp.2023.154808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 08/24/2023] [Accepted: 09/07/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Pulmonary adenocarcinoma shows different prognosis even in the same pathological subtype and stage. In this study, it is aimed to investigate the relationship between tumour budding and known prognostic values and clinicopathological features in pulmonary adenocarcinoma. METHODS In this study, there have been 77 patients diagnosed with primary pulmonary adenocarcinoma. In the evaluation process, the number of budding between 0 and 4 is accepted as low budding (Bd1), the number of budding between 5 and 9 is considered as medium budding (Bd2), and the number of budding above 10 is considered as high budding (Bd3). RESULTS According to the findings of the study, it can be seen that there is a statistical difference between tumour budding and stromal fibrosis (p < 0.001). The presence of pleural invasion, lymph vascular invasion and perineural invasion in patients with Bd3 is found to be statistically higher than the patients with Bd1 (p = 0.048) (p = 0.041) (p = 0.029). CONCLUSIONS Tumour budding has been associated with pleural invasion, lymph vascular invasion, perineural invasion, and stromal fibrosis. This study is the first to show the relationship between tumour budding and stromal fibrosis in pulmonary adenocarcinomas. The role of tumour budding in lung cancers remains to be clarified.
Collapse
Affiliation(s)
| | - Hayriye Tatli Dogan
- Department of Pathology, Ankara Yildirim Beyazit University, Ankara, Turkey.
| | - Elif Dogan
- Department of Pathology, Ankara City Hospital, Ankara, Turkey.
| | | | - Bulent Kocer
- Department of Thoracic Surgery, Ankara City Hospital, Ankara, Turkey.
| | | | - Erdal Yekeler
- Department of Thoracic Surgery, Ankara City Hospital, Ankara, Turkey.
| |
Collapse
|
7
|
Luo L, Liu H. High-grade tumor budding is a risk factor for survival in patients with laryngeal squamous cell carcinoma. Braz J Otorhinolaryngol 2023; 89:101310. [PMID: 37678011 PMCID: PMC10495643 DOI: 10.1016/j.bjorl.2023.101310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/07/2023] [Accepted: 08/12/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE With the increasing incidence and mortality of laryngeal squamous cell carcinoma worldwide, researchers continue to search for novel prognostic factors and treatment methods for preventing early laryngeal squamous cell carcinoma from becoming advanced laryngeal squamous cell carcinoma. This study aims to determine if tumor budding is an independent risk factor associated with the survival of patients with laryngeal squamous cell carcinoma. METHODS 268 cases of laryngeal squamous cell carcinoma were studied, and tumor budding was analyzed for associations with clinicopathological features and clinical outcomes. RESULTS Tumor budding was divided into low-grade tumor budding (0-6/0.785 mm2) and high-grade tumor budding (≥7/0.785 mm2) based on the results of the receiver operating characteristics curve analysis. Logistic regression analysis showed that smaller tumor cell nests, the low levels of tumor-infiltrating lymphocytes, and higher pathological T staging were the risk factors for high-grade tumor budding (p < 0.05). In the low-grade tumor budding group, there was no statistic difference in survival between patients without tumor budding and those with 1-6/0.785 mm2 tumor budding. Multivariate survival analysis showed high-grade tumor budding (p < 0.001) was independent prognostic factors for disease-free survival and overall survival in laryngeal squamous cell carcinoma. High-grade tumor budding was also an independent prognostic factor for disease-free survival (p = 0.037) and overall survival (p = 0.009) in T1-2N0 laryngeal squamous cell carcinoma. CONCLUSIONS Smaller tumor cell nests, the low levels of tumor-infiltrating lymphocytes, and higher pathological T staging were closely associated with high-grade tumor budding in laryngeal squamous cell carcinoma. High-grade tumor budding may be an adverse risk factor that affects not only the disease-free survival and overall survival of laryngeal squamous cell carcinoma patients but also the survival of T1-2N0 laryngeal squamous cell carcinoma patients. LEVEL OF EVIDENCE Level 4.
Collapse
Affiliation(s)
- Li Luo
- Capital Medical University, Beijing Tongren Hospital, Beijing Key Laboratory of Head and Neck Molecular Diagnostic Pathology, Department of Pathology, Beijing, China; Capital Medical University, Beijing Luhe Hospital, Department of Pathology, Beijing, China
| | - Honggang Liu
- Capital Medical University, Beijing Tongren Hospital, Beijing Key Laboratory of Head and Neck Molecular Diagnostic Pathology, Department of Pathology, Beijing, China.
| |
Collapse
|
8
|
Zombori-Tóth N, Hegedűs F, Almási S, Sejben A, Tiszlavicz L, Furák J, Cserni G, Zombori T. Proposal of a grading system for squamous cell carcinoma of the lung - the prognostic importance of tumour budding, single cell invasion, and nuclear diameter. Virchows Arch 2023; 483:393-404. [PMID: 37555982 PMCID: PMC10542270 DOI: 10.1007/s00428-023-03612-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/16/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023]
Abstract
The prognostic markers of lung squamous cell carcinoma (LSCC) are less investigated. The aim of our study was to evaluate tumour budding (TB), minimal cell nest size, nuclear diameter (ND), and spread through air spaces (STAS) among patients with resected LSCC, semi-quantitatively. Furthermore, we aimed to identify a grading system for the best prognostic stratification of LSCC. Patients who underwent surgical resection at the Department of Surgery, University of Szeged between 2010 and 2016 were included. Follow-up data were collected from medical charts. Morphological characteristics were recorded from histologic revision of slides. Kaplan-Meier analysis, log rank test and Cox proportional-hazards model, ROC curve analysis, and intraclass correlation were utilised. Altogether 220 patients were included. In univariate analysis, higher degree of TB, infiltrative tumour border, larger ND, the presence of single cell invasion (SCI) and STAS were associated with adverse prognosis. Based on our results, we proposed an easily applicable grading scheme focusing on TB, ND, and SCI. In multivariate analysis, the proposed grading system (pOS < 0.001, pRFS < 0.001) and STAS (pOS = 0.008, pRFS < 0.001) were independent prognosticators. Compared to the previously introduced grading systems, ROC curve analysis revealed that the proposed grade had the highest AUC values (AUCOS: 0.83, AUCRFS: 0.78). Each category of the proposed grading system has good (ICC: 0.79-0.88) reproducibility. We validated the prognostic impact of TB, SCI, ND, and STAS in LSCC. We recommend a reproducible grading system combining TB, SCI, and ND for proper prognostic stratification of LSCC patients. Further research is required for validation of this grading scheme.
Collapse
Affiliation(s)
| | - Fanni Hegedűs
- Department of Pathology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - Szintia Almási
- Department of Pathology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - Anita Sejben
- Department of Pathology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - László Tiszlavicz
- Department of Pathology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - József Furák
- Department of Surgery, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - Gábor Cserni
- Department of Pathology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Tamás Zombori
- Department of Pathology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary.
| |
Collapse
|
9
|
Hrudka J, Prouzová Z, Kendall Bártů M, Hojný J, Čapka D, Zavillová N, Matěj R, Waldauf P. Immune cell infiltration, tumour budding, and the p53 expression pattern are important predictors in penile squamous cell carcinoma: a retrospective study of 152 cases. Pathology 2023:S0031-3025(23)00124-1. [PMID: 37316384 DOI: 10.1016/j.pathol.2023.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/12/2023] [Accepted: 03/28/2023] [Indexed: 06/16/2023]
Abstract
Penile squamous cell carcinoma (pSCC) is a rare malignancy with a slowly increasing incidence and variable prognosis. Regional lymph node involvement signifies poor prognosis but represents a late sign, and more prognostic markers for effective patient risk stratification are urgently needed. In this retrospective study, 152 tumour samples with formalin-fixed, paraffin-embedded tissue were analysed for traditional pathological variables, tumour budding, p53, p16, and mismatch repair proteins (MMR) immunohistochemistry. The density of tumour lymphocytic infiltrate was also determined, using subjective evaluation by two pathologists (brisk/non-brisk/absent) and also using the immunoscore method, which categorised the cohort into five immunoscore groups according to the number of CD3+ and CD8+ T-cells in both the tumour centre and tumour invasion front. Only one case (0.6%) was MMR-deficient. Tumour budding count ≥5 tumour buds/20× power field and non-brisk/absent lymphocytic infiltrate were significant negative predictors of both the overall survival (OS) and cancer-specific survival (CSS), whereas a low immunoscore was a significant marker of shorter OS but not CSS. Advanced pT stage (3+4) was a significant marker of shorter CSS but not OS. In the multivariate analysis, high-grade budding was a significant parameter if adjusted for the patient's age and associated variables, except for the pN stage. The lymphocytic infiltrate retained its prognostic significance if adjusted for age and associated variables. The negative prognostic significance of the previously described parameters (lymphatic, venous, and perineural invasion, regional lymph node metastasis, and p53 mutated profile) were confirmed in our study. Grade, histological subtype, and HPV status (as determined by p16 immunohistochemistry) showed, surprisingly, little or no prognostic significance.
Collapse
Affiliation(s)
- Jan Hrudka
- Department of Pathology, 3rd Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic.
| | - Zuzana Prouzová
- Department of Pathology, 3rd Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic; Department of Pathology, 1st Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - Michaela Kendall Bártů
- Department of Pathology, 1st Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - Jan Hojný
- Department of Pathology, 1st Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - David Čapka
- Department of Urology, 3rd Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Nicolette Zavillová
- Department of Urology, 3rd Faculty of Medicine of Charles University, Thomayer University Hospital, Prague, Czech Republic
| | - Radoslav Matěj
- Department of Pathology, 3rd Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic; Department of Pathology, 1st Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic; Department of Pathology and Molecular Medicine, 3rd Faculty of Medicine, Charles University, Thomayer University Hospital, Prague, Czech Republic
| | - Petr Waldauf
- Department of Anaesthesia and Intensive Care Medicine, 3rd Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| |
Collapse
|
10
|
Wankhede D, Hofman P, Grover S. Prognostic impact of tumour budding in squamous cell carcinoma of the lung: a systematic review and meta-analysis. Histopathology 2023; 82:521-530. [PMID: 36217904 DOI: 10.1111/his.14822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/27/2022] [Accepted: 10/06/2022] [Indexed: 11/27/2022]
Abstract
Tumour budding is an established prognostic factor in various solid tumours, including colorectal cancers and oral squamous cell carcinomas. However, its role is unclear and needs to be defined for squamous cell carcinoma of the lung (LSCC). Hence, we conducted a systematic review and meta-analysis investigating the prognostic role of tumour budding in LSCC. PubMed, Embase and Scopus were searched for peer-reviewed literature investigating the association between tumour budding and survival outcomes or clinicopathological variables in LSCC. The primary outcomes were pooled estimates for overall and recurrence-free survival with hazard ratio (HR) as the effect measure. The association between tumour budding and clinicopathological parameters was also investigated. Of 243 studies, nine were included, comprising 2546 patients. An increased risk of death [HR = 1.76, 95% confidence interval (CI) = 1.50-2.05, P < 0.00001] and recurrence (HR = 1.37, 95% CI = 1.12-1.68, P = 0.003) was evident in patients with high-grade tumour budding. Sensitivity and subgroup analyses revealed consistent results. Pathological stage II, lymph node metastasis, lymphovascular and pleural invasion were associated with high-grade tumour budding. Tumour budding is a new and promising prognostic factor in patients with LSCC. However, pervasive heterogeneity and publication bias reduces the credibility of these findings and the applicability of tumour budding in clinical practice. Future studies are required to standardise reporting on tumour budding in LSCC.
Collapse
Affiliation(s)
- D Wankhede
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - P Hofman
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, University Côte d'Azur, Nice.,Institute for Research on Cancer and Ageing, Nice (IRCAN), INSERM U1081 and UMR CNRS 7284, Team 4, Nice.,Hospital-Integrated Biobank BB-0033-00025, Pasteur Hospital, Nice.,University Hospital Federation OncoAge, CHU de Nice, University Côte d'Azur, Nice, France
| | - S Grover
- Centre for Genetic Epidemiology, Institute for Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany
| |
Collapse
|
11
|
Okcu O, Şen B, Aşkan G, Öztürk Ç, Öztürk SD, Bedir R. Tumor Budding is an Independent Prognostic Factor to Predict Overall Survival in Endometrial Endometrioid Carcinoma: A Retrospective Study. Int J Surg Pathol 2023; 31:26-37. [PMID: 35899294 DOI: 10.1177/10668969221116541] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objective. Tumor budding defined as a tumor cell nest away from the main tumor, has been found to be associated with prognostic parameters in many cancer types. We aimed to investigate the relationship between tumor budding and clinicopathological parameters in endometrioid endometrial carcinomas, as well as its prognostic importance. Materials and Methods. One hundred four patients who underwent surgical resection with diagnosis of endometrioid endometrial carcinomas between June 2011 and May 2020 were included. The area where tumor budding was the most prominent was determined, and tumor budding was counted from hematoxylin and eosin-stained section at one high power field (X 200). By performing ROC analysis, the cut off value was obtained in order to divide the patients into low and high tumor budding groups. Results. The cut off value was determined as 1/0.95 mm2 according to the ROC analysis. Tumor budding was observed in 24 (23%) patients. Tumor budding significantly associated with poor overall survival (P < .001), distant metastasis (P = .001), presence of angiolymphatic invasion (P < .001), lymph node metastasis (P = .024), cervical invasion (P < .001), high FIGO grade (P < .001), large tumor size (P = .004). In multivarate analysis, tumor budding and age were found to be an independent risk factor for overall survival (P = .003, P = .014 respectively). Conclusion. Tumor budding is a significant morphological parameter independent of other prognostic parameters in endometrioid endometrial carcinomas. Standardizing the assesment and scoring of tumor budding, as well as including this entity in routine pathology reports could light the way for ideas in the risk analysis of patients.
Collapse
Affiliation(s)
- Oğuzhan Okcu
- Pathology Department, 187475Recep Tayyip Erdoğan University Training and Research Hospital, Turkey
| | - Bayram Şen
- Biochemistry Department, 187475Recep Tayyip Erdoğan University Training and Research Hospital, Turkey
| | - Gökçe Aşkan
- Pathology Department, 187475Recep Tayyip Erdoğan University Training and Research Hospital, Turkey
| | - Çiğdem Öztürk
- Pathology Department, 187475Recep Tayyip Erdoğan University Training and Research Hospital, Turkey
| | - Seda Duman Öztürk
- Pathology Department, 187475Recep Tayyip Erdoğan University Training and Research Hospital, Turkey
| | - Recep Bedir
- Faculty of Medicine, Department of Pathology, Recep Tayyip Erdoğan University, Turkey
| |
Collapse
|
12
|
Vascular Invasion Predicts Recurrence in Stage IA2-IB Lung Adenocarcinoma but not Squamous Cell Carcinoma. Clin Lung Cancer 2022; 24:e126-e133. [PMID: 36631388 DOI: 10.1016/j.cllc.2022.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/02/2022] [Accepted: 12/20/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Lymphovascular invasion (LVI) is an adverse prognostic feature in resected stage I non-small cell lung cancer (NSCLC); however, it is unclear if the prognostic significance applies to both lung adenocarcinoma (LUAD) and squamous cell carcinoma (LUSC). MATERIALS AND METHODS A retrospective review of H&E-stained slides from surgically resected AJCC 8th ed. stage IA2-IB LUAD (n = 344) and LUSC (n = 102) from two institutions was performed. LVI was defined as either lymphatic (LI) or vascular (VI) invasion. Outcomes were assessed by 5-year recurrence-free survival (RFS) estimates using the Kaplan-Meier method. RESULTS The cohorts of LUAD and LUSC showed no significant differences in 5-year RFS (81% each), stage, age, race, or surgical procedure. The presence of LVI, VI, and LI was predictive of 5-year RFS for LUAD (LVI + 71% vs. LVI - 92%, P < 0.001; VI + 64% vs. VI - 90%, P < 0.001; LI + 75% vs. LI - 84%, P = 0.030) but not LUSC (LVI + 84% vs. LVI - 79%, P = 0.740; VI + 83% vs. VI- 80%, P = 0.852; LI + 84% vs. LI - 81%, P = 0.757). Among LUAD with LVI, VI was a stronger predictor of 5-year RFS than the remaining subset of VI-LI + tumors (64% vs. 87%, P = 004). Subset analysis of LI among LUAD stratified by VI showed no significant prognostic advantage to adding LI for risk stratification (VI-LI + 87% vs. VI-LI - 92%, P = 0.347 & VI+LI + 62% vs. VI + LI- 66%, P = 0.422). VI was present in 36% of LUAD. CONCLUSION Vascular invasion is a strong predictor of recurrence in stage IA2-IB LUAD but not in LUSC. Adjuvant therapy trials should be directed at this subgroup.
Collapse
|
13
|
Derani H, Becker AS, Hakenberg O, Erbersdobler A. Evaluation of the Cellular Dissociation Grading, Based on Tumor Budding and Cell Nest Size, in Squamous Cell Carcinoma of the Penis. Cancers (Basel) 2022; 14:4949. [PMID: 36230870 PMCID: PMC9564293 DOI: 10.3390/cancers14194949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/23/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022] Open
Abstract
The "Cellular Dissociation Grade" (CDG) is based on tumor cell budding and cell nest size. Many studies have examined the CDG in squamous cell carcinomas of other organs such as the lungs, oral cavity, pharynx, larynx, cervix and esophagus. In this study, the CDG was examined in 109 cases of invasive penile squamous cell carcinoma that were treated at the University Medicine Rostock between 2014 and 2022. Furthermore, its correlation with the pathologic status of regional lymph nodes (pN) as the main prognostic factor was verified. Finally, cellular dissociation grading was compared with classic WHO grading. The results showed that pN in penile squamous cell carcinoma showed a highly significant association with the CDG and no statistically significant association with WHO grading. These results support the notion that cellular dissociation grading is an important prognostic factor for squamous cell carcinoma.
Collapse
Affiliation(s)
- Hayel Derani
- Institute of Pathology, University Medicine Rostock, 18055 Rostock, Germany
| | - Anne-Sophie Becker
- Institute of Pathology, University Medicine Rostock, 18055 Rostock, Germany
| | - Oliver Hakenberg
- Department of Urology, University Medicine Rostock, 18055 Rostock, Germany
| | | |
Collapse
|
14
|
Jesinghaus M, Boxberg M, Schmitt M, Kriegsmann M, Harms A, Lang C, Muley T, Winter H, Kriegsmann K, Warth A, Stenzinger A, Denkert C, Hoffmann H, Safi S, Weichert W. Cellular dissociation grading on biopsies of pulmonary squamous cell carcinoma provides prognostic information across all stages and is congruent with resection specimen grading. J Pathol Clin Res 2022; 8:567-578. [PMID: 36111649 PMCID: PMC9535098 DOI: 10.1002/cjp2.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/08/2022] [Accepted: 08/31/2022] [Indexed: 12/29/2022]
Abstract
Grading of squamous cell carcinomas (SCCs) based on tumour budding and cell nest size has been termed cellular dissociation grading (CDG) and was suggested as a robust outcome predictor when assessed in biopsies and resections of various extrapulmonary SCCs. In pulmonary SCC (pSCC), this has so far been shown only for resected cancers. As most lung cancers are inoperable, it is of utmost importance to clarify whether the prognostic impact of CDG is retained in the biopsy setting. Two independent pSCC biopsy cohorts from Munich (n = 134, non-resected) and Heidelberg (n = 135, resected) were assessed. Tumour budding and cell nest size measures were assembled into the three-tiered CDG system (G1-G3). Data were correlated with clinicopathological parameters and overall- (OS), disease-specific- (DSS), and disease-free survival (DFS). Interobserver variability and concordance between biopsy and resection specimen were also investigated. CDG was highly congruent between biopsy and resection specimens (κ = 0.77, p < 0.001). In both pSCC cohorts, biopsy-derived CDG strongly impacted on OS, DSS, and DFS (e.g. DFS: p < 0.001). In multivariate survival analyses, CDG remained a stage independent predictor of survival in both cohorts (DFS: p < 0.001 respectively; hazard ratio Munich cohort: CDG-G2: 4.31, CDG-G3; 5.14; Heidelberg cohort: CDG-G2: 5.87, CDG-G3: 9.07). Interobserver agreement for CDG was almost perfect (κ = 0.84, p < 0.001). We conclude that assessment of CDG based on tumour budding and cell nest size is feasible on pSCC biopsies and harbours stage independent prognostic information in resectable as well as non-resectable pSCC. Integration of this grading approach into clinicopathological routine should be considered.
Collapse
Affiliation(s)
- Moritz Jesinghaus
- Institute of Pathology, University Hospital MarburgMarburgGermany,Institute of Pathology, Technical University MunichMunichGermany
| | - Melanie Boxberg
- Institute of Pathology, Technical University MunichMunichGermany,Institute of Pathology Munich NorthMunichGermany
| | - Maxime Schmitt
- Institute of Pathology, University Hospital MarburgMarburgGermany,Institute of Pathology, Technical University MunichMunichGermany
| | - Mark Kriegsmann
- Institute of Pathology, University Hospital HeidelbergHeidelbergGermany,Member of the German Center for Lung Research (DZL)HeidelbergGermany
| | - Alexander Harms
- Institute of Pathology, University Hospital HeidelbergHeidelbergGermany
| | - Corinna Lang
- Institute of Pathology, Technical University MunichMunichGermany
| | - Thomas Muley
- Member of the German Center for Lung Research (DZL)HeidelbergGermany,Translational Lung Research Center Heidelberg (TLRC‐H)HeidelbergGermany,Translational Research UnitThoraxklinik at Heidelberg University HospitalHeidelbergGermany
| | - Hauke Winter
- Member of the German Center for Lung Research (DZL)HeidelbergGermany,Translational Lung Research Center Heidelberg (TLRC‐H)HeidelbergGermany,Department of Thoracic SurgeryThoraxklinik at Heidelberg University HospitalHeidelbergGermany
| | - Katharina Kriegsmann
- Department of Hematology, Oncology and RheumatologyUniversity Hospital HeidelbergHeidelbergGermany
| | | | - Albrecht Stenzinger
- Institute of Pathology, University Hospital HeidelbergHeidelbergGermany,Member of the German Center for Lung Research (DZL)HeidelbergGermany
| | - Carsten Denkert
- Institute of Pathology, University Hospital MarburgMarburgGermany
| | - Hans Hoffmann
- Department of Thoracic SurgeryKlinikum Rechts der Isar (MRI)MunichGermany
| | - Seyer Safi
- Department of Thoracic SurgeryKlinikum Rechts der Isar (MRI)MunichGermany
| | - Wilko Weichert
- Institute of Pathology, Technical University MunichMunichGermany,German Cancer Consortium (DKTK), Partner Site MunichHeidelbergGermany,Comprehensive Cancer Center Munich (CCCM)MunichGermany
| |
Collapse
|
15
|
Fan J, DeFina SM, Wang H. Prognostic Value of Selected Histologic Features for Lung Squamous Cell Carcinoma. EXPLORATORY RESEARCH AND HYPOTHESIS IN MEDICINE 2022; 7:165-168. [PMID: 36247021 PMCID: PMC9563092 DOI: 10.14218/erhm.2021.00071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The recent histologic subtyping of lung adenocarcinoma has demonstrated the prognostic values of histologic patterns in this malignancy. However, the histological features of lung squamous cell carcinoma (SCC) are much less established. This short review discusses several promising histological prognostic markers for SCC, including tumor budding, tumor cell nesting, and the spreading of tumors through air spaces. Wherever appropriate, the biological significance of these morphological features was also discussed. The investigators consider that histological prognostic markers are highly valuable in understanding the cancer biology of SCC, and in guiding clinical treatment. However, larger clinical cohorts are needed to better establish the prognostic values of the aforementioned histological markers. The application of modern technologies, including machine-learning, would make the histological analysis accurate and reproducible.
Collapse
Affiliation(s)
- Justine Fan
- The Haverford School, 450 Lancaster Ave., Haverford, PA, USA
| | - Samuel M. DeFina
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - He Wang
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
- Correspondence to: He Wang, Department of Pathology, Yale University School of Medicine, New Haven, CT 06510, USA. Tel: +1-203-214-2786, Fax: +1-203-214-5007,
| |
Collapse
|
16
|
Farah M, Milton DR, Gross ND, Nagarajan P, Gu J, Curry JL, Ivan D, Torres-Cabala CA, Myers JN, Prieto VG, Aung PP. Histopathologic features predictive of metastasis and survival in 230 patients with cutaneous squamous cell carcinoma of the head and neck and non-head and neck locations: a single-center retrospective study. J Eur Acad Dermatol Venereol 2022; 36:1246-1255. [PMID: 35426183 DOI: 10.1111/jdv.18147] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/18/2022] [Accepted: 03/15/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Staging systems for cutaneous squamous cell carcinoma (cSCC) produce inconsistent risk stratification. OBJECTIVE The aim of this study was to identify further prognostic parameters for better stratification. METHODS We retrospectively analysed the prognostic significance of clinicopathologic parameters of 230 patients who underwent primary excision of invasive cSCC of the head and neck (n = 115) and non-head and non-neck (n = 115) locations. In addition to known high-risk features, we analysed tumour nest shape, invasion pattern, lymphoid response pattern and tumour budding. RESULTS On multivariable analysis, lymphovascular invasion (LVI) and high tumour budding predicted worse disease-specific survival, and ulceration, LVI and high tumour budding predicted worse overall survival. Only ulceration was independently associated with risk of nodal metastasis. CONCLUSION High tumour budding, LVI and ulceration are independently associated with poor outcome in cSCC and may be used to refine cSCC prognostic stratification, which is crucial to optimize clinical decision and to identify patients who are more likely to benefit from more aggressive interventions or clinical trials.
Collapse
Affiliation(s)
- M Farah
- Department of Pathology, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - D R Milton
- Department of Biostatistics, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - N D Gross
- Head and Neck Surgery, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - P Nagarajan
- Department of Pathology, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J Gu
- Cytogenetic Technology Program, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J L Curry
- Department of Pathology, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - D Ivan
- Department of Pathology, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C A Torres-Cabala
- Department of Pathology, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J N Myers
- Head and Neck Surgery, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - V G Prieto
- Department of Pathology, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - P P Aung
- Department of Pathology, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
17
|
Thakur N, Ailia MJ, Chong Y, Shin OR, Yim K. Tumor Budding as a Marker for Poor Prognosis and Epithelial-Mesenchymal Transition in Lung Cancer: A Systematic Review and Meta-Analysis. Front Oncol 2022; 12:828999. [PMID: 35719992 PMCID: PMC9201279 DOI: 10.3389/fonc.2022.828999] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 05/05/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Currently, tumor budding (TB) is considered to predict the prognosis of patients. The prognostic significance of TB has also been explored in patients with lung cancer, but has not been fully clarified. In the present meta-analysis, we evaluated the prognostic significance, clinicopathological value, and relationship with epithelial–mesenchymal transition (EMT) of TB in lung cancer. Methods The MEDLINE, EMBASE, and Cochrane databases were searched up to July 7, 2021, for the relevant articles that showed the relationship between TB and prognosis in patients with lung cancer. For statistical analysis, we used pooled hazard ratios (HRs) with their corresponding 95% confidence intervals (CIs) to assess the correlation between high-grade TB expression and overall survival (OS), disease-free survival (DFS), progression-free survival (PFS), clinicopathological factors, and EMT markers. Results A total of 3,784 patients from 10 independent studies were included in the statistical analysis. Our results indicated that high-grade TB was significantly associated with poor OS [HR 1.64 (95% CI, 1.43–1.87)] and DFS [HR 1.65 (95% CI, 1.22–2.25)]. In terms of clinicopathological characteristics, high-grade TB was associated with larger tumor size, higher T and N stage, pleural invasion, vascular invasion, lymphatic invasion, and severe nuclear atypia. Interestingly, smoking showed significant association with high-grade TB, despite the fact that previous studies could not show a significant relationship between them. Furthermore, through our systematic analysis, high-grade TB showed a significant relationship with EMT markers. Conclusion Our findings indicate that high-grade TB is associated with a worse prognosis in patients with lung cancer. TB evaluation should be implemented in routine pathological diagnosis, which may guide the patient’s treatment.
Collapse
Affiliation(s)
- Nishant Thakur
- Department of Hospital Pathology, The Catholic University of Korea, Seoul, South Korea
| | - Muhammad Joan Ailia
- Department of Hospital Pathology, The Catholic University of Korea, Seoul, South Korea
| | - Yosep Chong
- Department of Hospital Pathology, The Catholic University of Korea, Seoul, South Korea
| | - Ok Ran Shin
- Department of Hospital Pathology, The Catholic University of Korea, Seoul, South Korea
| | - Kwangil Yim
- Department of Hospital Pathology, The Catholic University of Korea, Seoul, South Korea
| |
Collapse
|
18
|
Li J, Li X, Yang J. A Novel Prognostic Stratified System Based on Tumor Budding and the Cell Nest Size in Ureter Urothelial Carcinoma. Appl Bionics Biomech 2022; 2022:6988237. [PMID: 35572056 PMCID: PMC9106466 DOI: 10.1155/2022/6988237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/07/2022] [Accepted: 04/12/2022] [Indexed: 11/18/2022] Open
Abstract
At present, malignant tumor stratification based on the TNM stage is very important for predicting patient prognosis and selecting appropriate treatment. The prognostic factor of ureter urothelial carcinoma is mainly based on the stage according to AJCC (8th) TNM classification. None of the histomorphologic features is recommended to assess patient's prognosis. Recently, a novel three-tiered grading system based on tumor budding and the cell nest size (referred as TBNS system) has been applied to be highly prognostic for some squamous cell carcinomas, including esophageal, pulmonary, uterine cervix cancer, and endocervical endocarcinoma. In this study, we explored the application of this TBNS grading system in ureter urothelial carcinoma consisting 87 surgically resected cases and no neoadjuvant therapy. Tumor budding and the cell nest size were assessed and correlated with clinicopathological data and survival. The results showed that higher tumor budding, cell nest size, and TBNS grading system were strongly related to shorter overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS). Multivariate survival analysis showed the TBNS grading system to be closely related to the independent prognosis of DFS and DSS. In conclusion, the TBNS grading system based on tumor budding and cell nest size, if further validated, could satisfactorily predict the prognosis of uterine urothelial carcinoma and be applicable in routine pathologic description of this cancer type.
Collapse
Affiliation(s)
- Jialin Li
- Department of Pathology, Jinzhou Medical University, Jinzhou, Liaoning, 40 Songpo Road, Linghe District, Jinzhou, Liaoning, China
| | - Xinyue Li
- Department of Pathology, Jinzhou Medical University, Jinzhou, Liaoning, 40 Songpo Road, Linghe District, Jinzhou, Liaoning, China
| | - Jing Yang
- Department of Pathology, Jinzhou Medical University, Jinzhou, Liaoning, 40 Songpo Road, Linghe District, Jinzhou, Liaoning, China
| |
Collapse
|
19
|
Dagher S, Sulaiman A, Bayle-Bleuez S, Tissot C, Grangeon-Vincent V, Laville D, Fournel P, Tiffet O, Forest F. Spread Through Air Spaces (STAS) Is an Independent Prognostic Factor in Resected Lung Squamous Cell Carcinoma. Cancers (Basel) 2022; 14:cancers14092281. [PMID: 35565410 PMCID: PMC9101151 DOI: 10.3390/cancers14092281] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/25/2022] [Accepted: 04/30/2022] [Indexed: 02/01/2023] Open
Abstract
Objective: There is no histoprognostic grading for lung squamous cell carcinoma (LUSC). Different prognostic factors have been described in the recent literature and are not always studied in parallel. Our objective was to search for morphological histopathological prognostic factors in LUSC. Materials and Methods: In this single-center retrospective study of 241 patients, all patients with LUSC who underwent surgical excision over a 12-year period were included. The primary endpoint was 5-year overall survival. Results: STAS was present in 86 (35.7%) patients. The presence of Spread Through Air Spaces (STAS) was correlated with tumor location (p < 0.001), pathological stage (p = 0.039), tumor differentiation (p = 0.029), percentage of necrosis (p = 0.004), presence of vascular and/or lymphatic emboli, budding (p = 0.02), single cell invasion (p = 0.002) and tumor nest size (p = 0.005). The percentage of tumor necrosis was correlated with the overall survival at 5 years: 44.6% of patients were alive when the percentage of necrosis was ≥50%, whereas 68.5% were alive at 5 years when the necrosis was <30% (p < 0.001). When vasculolymphatic emboli were present, the percentage of survival at 5 years was 42.5% compared to 65.5% when they were absent (p = 0.002). The presence of isolated cell invasion was correlated with a lower 5-year survival rate: 51.1% in the case of presence, versus 66% in the case of absence (p = 0.02). In univariate analysis, performance status, pathological stage pT or pN, pleural invasion, histopathological subtype, percentage of tumor necrosis, vasculolymphatic invasion, single-cell invasion, budding and tumor nest size correlated with the percentage of survival at 5 years. On multivariate analysis, only STAS > 3 alveoli (HR, 2.74; 95% CI, 1.18−6.33) was related to overall survival. Conclusion: In conclusion, extensive STAS is an independent factor of poor prognosis in LUSC. STAS is correlated with the presence of other poor prognostic factors such as emboli and pleural invasion and would reflect greater tumor aggressiveness.
Collapse
Affiliation(s)
- Sami Dagher
- Department of Pathology, University Hospital of Saint Etienne, 42055 Saint Etienne, France; (S.D.); (D.L.)
| | - Abdulrazzaq Sulaiman
- Department of Thoracic Surgery, University Hospital of Saint Etienne, 42055 Saint Etienne, France; (A.S.); (O.T.)
| | - Sophie Bayle-Bleuez
- Department of Pneumology, University Hospital of Saint Etienne, 42055 Saint Etienne, France;
| | - Claire Tissot
- Lucien Neuwirth Cancer Institute, 42271 Saint Etienne, France; (C.T.); (P.F.)
| | | | - David Laville
- Department of Pathology, University Hospital of Saint Etienne, 42055 Saint Etienne, France; (S.D.); (D.L.)
| | - Pierre Fournel
- Lucien Neuwirth Cancer Institute, 42271 Saint Etienne, France; (C.T.); (P.F.)
| | - Olivier Tiffet
- Department of Thoracic Surgery, University Hospital of Saint Etienne, 42055 Saint Etienne, France; (A.S.); (O.T.)
| | - Fabien Forest
- Department of Pathology, University Hospital of Saint Etienne, 42055 Saint Etienne, France; (S.D.); (D.L.)
- Department of Molecular Biology of Solid Tumors, University Hospital of Saint Etienne, 42055 Saint Etienne, France
- Correspondence: ; Tel.: +33-(0)-477-127-734
| |
Collapse
|
20
|
Tumour Cell Budding and Spread Through Air Spaces in Squamous Cell Carcinoma of the Lung – Determination and Validation of optimal prognostic cut-offs. Lung Cancer 2022; 169:1-12. [DOI: 10.1016/j.lungcan.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/22/2022] [Accepted: 04/25/2022] [Indexed: 11/22/2022]
|
21
|
Dewaguet J, Copin MC, Duhamel A, Faivre JB, Deken V, Sedlmair M, Flohr T, Schmidt B, Cortot A, Wasielewski E, Remy J, Remy-Jardin M. Dual-Energy CT Perfusion of Invasive Tumor Front in Non-Small Cell Lung Cancers. Radiology 2021; 302:448-456. [PMID: 34783594 DOI: 10.1148/radiol.2021210600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Active endothelial cell proliferation occurs at the tumor edge, known as the invading-tumor front. This study focused on perfusion analysis of non-small cell lung cancers. Purpose To analyze dual-phase, dual-energy CT perfusion according to the degree of tumor hypoxia. Materials and Methods This prospective study was performed 2016-2017. A two-phase dual-energy CT protocol was obtained for consecutive participants with operable non-small cell lung cancer. The first pass and delayed iodine concentration within the tumor and normalized iodine uptake, corresponding to the iodine concentration within the tumor normalized to iodine concentration within the aorta, were calculated for the entire tumor and within three peripheral layers automatically segmented (ie, 2-mm-thick concentric subvolumes). The expression of the membranous carbonic anhydrase (mCA) IX, a marker of tumor hypoxia, was assessed in tumor specimens. Comparative analyses according to the histologic subtypes, type of resected tumors, and mCA IX expression were performed. Results There were 33 mCA IX-positive tumors and 16 mCA IX-negative tumors. In the entire tumor, the mean normalized iodine uptake was higher on delayed than on first-pass acquisitions (0.35 ± 0.17 vs 0.13 ± 0.15, respectively; P < .001). A single layer, located at the edge of the tumor, showed higher values of the iodine concentration (median, 0.53 mg/mL vs 0.21 mg/mL, respectively; P = .03) and normalized iodine uptake (0.04 vs 0.02, respectively; P = .03) at first pass in mCA IX-positive versus mCA IX-negative tumors. Within this layer, a functional profile of neovascularization was found in 23 of 33 (70%) of mCA IX-positive tumors, and the median mCA IX score of these tumors was higher than in tumors with a nonfunctional profile of neovascularization (median mCA IX score, 20 vs 2, respectively; P = .03). Conclusion A two-phase dual-energy CT examination depicted higher perfusion between the tumor edge and lung parenchyma in hypoxic tumors. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Murphy and Ryan in this issue.
Collapse
Affiliation(s)
- Julie Dewaguet
- From the Departments of Thoracic Imaging (J.D., J.B.F., J.R., M.R.J.) and Biomedical Statistics (A.D., V.D.), ULR 2694 Evaluation des Technologies de Santé et des Pratiques Médicales (METRICS), and Department of Pathology (M.C.C.), CHU Lille, University of Lille, 59000 Lille, France; Department of Research and Development, Siemens Healthcare, Computed Tomography, Forchheim, Germany (M.S., T.F., B.S.); and Department of Thoracic Oncology, Calmette Hospital, CHU Lille, University of Lille, Lille, France (A.C., E.W.)
| | - Marie-Christine Copin
- From the Departments of Thoracic Imaging (J.D., J.B.F., J.R., M.R.J.) and Biomedical Statistics (A.D., V.D.), ULR 2694 Evaluation des Technologies de Santé et des Pratiques Médicales (METRICS), and Department of Pathology (M.C.C.), CHU Lille, University of Lille, 59000 Lille, France; Department of Research and Development, Siemens Healthcare, Computed Tomography, Forchheim, Germany (M.S., T.F., B.S.); and Department of Thoracic Oncology, Calmette Hospital, CHU Lille, University of Lille, Lille, France (A.C., E.W.)
| | - Alain Duhamel
- From the Departments of Thoracic Imaging (J.D., J.B.F., J.R., M.R.J.) and Biomedical Statistics (A.D., V.D.), ULR 2694 Evaluation des Technologies de Santé et des Pratiques Médicales (METRICS), and Department of Pathology (M.C.C.), CHU Lille, University of Lille, 59000 Lille, France; Department of Research and Development, Siemens Healthcare, Computed Tomography, Forchheim, Germany (M.S., T.F., B.S.); and Department of Thoracic Oncology, Calmette Hospital, CHU Lille, University of Lille, Lille, France (A.C., E.W.)
| | - Jean-Baptiste Faivre
- From the Departments of Thoracic Imaging (J.D., J.B.F., J.R., M.R.J.) and Biomedical Statistics (A.D., V.D.), ULR 2694 Evaluation des Technologies de Santé et des Pratiques Médicales (METRICS), and Department of Pathology (M.C.C.), CHU Lille, University of Lille, 59000 Lille, France; Department of Research and Development, Siemens Healthcare, Computed Tomography, Forchheim, Germany (M.S., T.F., B.S.); and Department of Thoracic Oncology, Calmette Hospital, CHU Lille, University of Lille, Lille, France (A.C., E.W.)
| | - Valérie Deken
- From the Departments of Thoracic Imaging (J.D., J.B.F., J.R., M.R.J.) and Biomedical Statistics (A.D., V.D.), ULR 2694 Evaluation des Technologies de Santé et des Pratiques Médicales (METRICS), and Department of Pathology (M.C.C.), CHU Lille, University of Lille, 59000 Lille, France; Department of Research and Development, Siemens Healthcare, Computed Tomography, Forchheim, Germany (M.S., T.F., B.S.); and Department of Thoracic Oncology, Calmette Hospital, CHU Lille, University of Lille, Lille, France (A.C., E.W.)
| | - Martin Sedlmair
- From the Departments of Thoracic Imaging (J.D., J.B.F., J.R., M.R.J.) and Biomedical Statistics (A.D., V.D.), ULR 2694 Evaluation des Technologies de Santé et des Pratiques Médicales (METRICS), and Department of Pathology (M.C.C.), CHU Lille, University of Lille, 59000 Lille, France; Department of Research and Development, Siemens Healthcare, Computed Tomography, Forchheim, Germany (M.S., T.F., B.S.); and Department of Thoracic Oncology, Calmette Hospital, CHU Lille, University of Lille, Lille, France (A.C., E.W.)
| | - Thomas Flohr
- From the Departments of Thoracic Imaging (J.D., J.B.F., J.R., M.R.J.) and Biomedical Statistics (A.D., V.D.), ULR 2694 Evaluation des Technologies de Santé et des Pratiques Médicales (METRICS), and Department of Pathology (M.C.C.), CHU Lille, University of Lille, 59000 Lille, France; Department of Research and Development, Siemens Healthcare, Computed Tomography, Forchheim, Germany (M.S., T.F., B.S.); and Department of Thoracic Oncology, Calmette Hospital, CHU Lille, University of Lille, Lille, France (A.C., E.W.)
| | - Bernhard Schmidt
- From the Departments of Thoracic Imaging (J.D., J.B.F., J.R., M.R.J.) and Biomedical Statistics (A.D., V.D.), ULR 2694 Evaluation des Technologies de Santé et des Pratiques Médicales (METRICS), and Department of Pathology (M.C.C.), CHU Lille, University of Lille, 59000 Lille, France; Department of Research and Development, Siemens Healthcare, Computed Tomography, Forchheim, Germany (M.S., T.F., B.S.); and Department of Thoracic Oncology, Calmette Hospital, CHU Lille, University of Lille, Lille, France (A.C., E.W.)
| | - Alexis Cortot
- From the Departments of Thoracic Imaging (J.D., J.B.F., J.R., M.R.J.) and Biomedical Statistics (A.D., V.D.), ULR 2694 Evaluation des Technologies de Santé et des Pratiques Médicales (METRICS), and Department of Pathology (M.C.C.), CHU Lille, University of Lille, 59000 Lille, France; Department of Research and Development, Siemens Healthcare, Computed Tomography, Forchheim, Germany (M.S., T.F., B.S.); and Department of Thoracic Oncology, Calmette Hospital, CHU Lille, University of Lille, Lille, France (A.C., E.W.)
| | - Eric Wasielewski
- From the Departments of Thoracic Imaging (J.D., J.B.F., J.R., M.R.J.) and Biomedical Statistics (A.D., V.D.), ULR 2694 Evaluation des Technologies de Santé et des Pratiques Médicales (METRICS), and Department of Pathology (M.C.C.), CHU Lille, University of Lille, 59000 Lille, France; Department of Research and Development, Siemens Healthcare, Computed Tomography, Forchheim, Germany (M.S., T.F., B.S.); and Department of Thoracic Oncology, Calmette Hospital, CHU Lille, University of Lille, Lille, France (A.C., E.W.)
| | - Jacques Remy
- From the Departments of Thoracic Imaging (J.D., J.B.F., J.R., M.R.J.) and Biomedical Statistics (A.D., V.D.), ULR 2694 Evaluation des Technologies de Santé et des Pratiques Médicales (METRICS), and Department of Pathology (M.C.C.), CHU Lille, University of Lille, 59000 Lille, France; Department of Research and Development, Siemens Healthcare, Computed Tomography, Forchheim, Germany (M.S., T.F., B.S.); and Department of Thoracic Oncology, Calmette Hospital, CHU Lille, University of Lille, Lille, France (A.C., E.W.)
| | - Martine Remy-Jardin
- From the Departments of Thoracic Imaging (J.D., J.B.F., J.R., M.R.J.) and Biomedical Statistics (A.D., V.D.), ULR 2694 Evaluation des Technologies de Santé et des Pratiques Médicales (METRICS), and Department of Pathology (M.C.C.), CHU Lille, University of Lille, 59000 Lille, France; Department of Research and Development, Siemens Healthcare, Computed Tomography, Forchheim, Germany (M.S., T.F., B.S.); and Department of Thoracic Oncology, Calmette Hospital, CHU Lille, University of Lille, Lille, France (A.C., E.W.)
| |
Collapse
|
22
|
Eckstein M, Kimmel C, Bruendl J, Weber F, Denzinger S, Gierth M, Burger M, Hartmann A, Otto W, Breyer J. Tumor budding correlates with tumor invasiveness and predicts worse survival in pT1 non-muscle-invasive bladder cancer. Sci Rep 2021; 11:17981. [PMID: 34504238 PMCID: PMC8429693 DOI: 10.1038/s41598-021-97500-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/23/2021] [Indexed: 12/24/2022] Open
Abstract
Tumor budding is defined as a single cell or a cluster of up to 5 tumor cells at the invasion front. Due to the difficulty of identifying patients at high risk for pT1 non-muscle-invasive bladder cancer (NMIBC) and the difficulties in T1 substaging, tumor budding was evaluated as a potential alternative and prognostic parameter in these patients. Tumor budding as well as growth pattern, invasion pattern and lamina propria infiltration were retrospectively evaluated in transurethral resection of the bladder (TURB) specimens from 92 patients with stage pT1 NMIBC. The presence of tumor budding correlated with multifocal tumors (p = 0.003), discontinuous invasion pattern (p = 0.039), discohesive growth pattern (p < 0.001) and extensive lamina propria invasion (p < 0.001). In Kaplan-Meier analysis, tumor budding was associated with significantly worse RFS (p = 0.005), PFS (p = 0.017) and CSS (p = 0.002). In patients who received BCG instillation therapy (n = 65), the absence of tumor budding was associated with improved RFS (p = 0.012), PFS (p = 0.011) and CSS (p = 0.022), with none of the patients suffering from progression or dying from the disease. Tumor budding is associated with a more aggressive and invasive stage of pT1 NMIBC and a worse outcome. This easy-to-assess parameter could help stratify patients into BCG therapy or early cystectomy treatment groups.
Collapse
Affiliation(s)
- Markus Eckstein
- Institute of Pathology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Charlotte Kimmel
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Landshuter Str. 65, 93053, Regensburg, Germany
| | - Johannes Bruendl
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Landshuter Str. 65, 93053, Regensburg, Germany
| | - Florian Weber
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Stefan Denzinger
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Landshuter Str. 65, 93053, Regensburg, Germany
| | - Michael Gierth
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Landshuter Str. 65, 93053, Regensburg, Germany
| | - Maximilian Burger
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Landshuter Str. 65, 93053, Regensburg, Germany
| | - Arndt Hartmann
- Institute of Pathology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Wolfgang Otto
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Landshuter Str. 65, 93053, Regensburg, Germany
| | - Johannes Breyer
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Landshuter Str. 65, 93053, Regensburg, Germany.
| |
Collapse
|
23
|
Kim HN, Lee SY, Kim BH, Kim CY, Kim A, Kim H. Prognostic value of tumor budding in gallbladder cancer: application of the International Tumor Budding Consensus Conference scoring system. Virchows Arch 2021; 478:1071-1078. [PMID: 33398430 DOI: 10.1007/s00428-020-03012-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/21/2020] [Accepted: 12/27/2020] [Indexed: 02/06/2023]
Abstract
Tumor budding (TB), a histopathological manifestation of epithelial-mesenchymal transition, is an important step in cancer invasion and metastasis development. TB has been considered a strong prognostic indicator in colorectal cancer. The International Tumor Budding Consensus Conference (ITBCC) scoring system is the standardized method used for patient outcome prediction in several human tumors. We investigated the clinicopathological implications and applicability of TB measured using the ITBCC scoring system in gallbladder cancer (GBC). The TB grades assigned to the 78 GBC patients were as follows: Bd1 (low TB), 41 (52.6%) patients; Bd2 (intermediate TB), 22 (28.2%) patients; and Bd3 (high TB), 15 (19.2%) patients. A higher TB grade correlated with a poorer histological differentiation (P < 0.000), higher pT category (P < 0.000), the involvement of surgical resection margin (P = 0.005), presence of nodal metastasis (P < 0.000), lymphatic and venous invasion (P < 0.000), and perineural invasion (P = 0.004). Univariate Cox regression analysis revealed that a poor histological grade, high pT category, lymphatic invasion, perineural invasion, and intermediate to high TB grades were associated with worse 5-year overall survival and disease-free survival. TB was not significantly associated with death or recurrence risk in multivariate Cox analysis. The interobserver agreement of TB grading was substantial. This study is the first to apply the ITBCC scoring system and suggest the prognostic value of TB in GBC.
Collapse
Affiliation(s)
- Han-Na Kim
- Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Soo Yeon Lee
- Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Baek-Hui Kim
- Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Chung-Yeul Kim
- Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Aeree Kim
- Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Hayeon Kim
- Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
| |
Collapse
|
24
|
Prognostic impact of tumor budding in endometrial carcinoma within distinct molecular subgroups. Mod Pathol 2021; 34:222-232. [PMID: 32728223 DOI: 10.1038/s41379-020-0626-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/10/2020] [Accepted: 07/10/2020] [Indexed: 12/21/2022]
Abstract
Tumor budding is a robust prognostic parameter in several tumor entities but is rarely investigated in endometrial carcinoma. We applied the recently standardized counting method from the International Tumor Budding Consensus Conference for colorectal cancer (ITBCC) on a cohort of 255 endometrial carcinomas with known molecular profiles according to The Cancer Genome Atlas (TCGA) subgroups. Our investigation aims to clarify the potential prognostic role of tumor budding in endometrial carcinoma in contrast to other known prognostic factors, including molecular factors. In addition, the microcystic elongated and fragmented (MELF) pattern and tumor budding were compared with respect to their potential as markers for epithelial-mesenchymal transition (EMT). Tumor budding was found in n = 67 (26.3%) tumors, with a very low mean of 0.7 buds per ×20 HE field. Tumor budding was significantly associated with depth of invasion, nodal status, lymphatic invasion (each p < 0.001), grading (p = 0.004), and vascular invasion (p = 0.01). Tumor budding showed moderate inter-observer-variability with prognostic stratification irrespective of the observer (κ-value = 0.448). In multivariate analysis, tumor budding served as a significant independent prognosticator for worse outcomes in overall and recurrence-free survival (HR 2.376 and 2.736, p < 0.001), but not when the TCGA subgroups entered into the analysis. In consequence, dependency had to be clarified in the subgroup analysis for Polymerase E mutated (POLEmut), mismatch repair deficient (MMRdef), nonspecific mutation profile (NSMP), and P53 aberrant (P53abn) endometrial carcinomas. A particular impact was identified in the intermediate prognostic groups of NSMP and MMRdef carcinomas. Tumor budding outperformed the MELF pattern in single and combined prognostic information. In conclusion, the presence of tumor budding alone is a promising, robust, and easy-to-apply prognostic parameter in endometrial carcinoma. In a morpho-molecular approach, it exerts its prognostic potential in the most clinically relevant subgroups of endometrial carcinoma and serves as a good biomarker for EMT.
Collapse
|
25
|
Chaperone-Mediated Autophagy Markers LAMP2A and HSC70 Are Independent Adverse Prognostic Markers in Primary Resected Squamous Cell Carcinomas of the Lung. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:8506572. [PMID: 33029283 PMCID: PMC7527932 DOI: 10.1155/2020/8506572] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 08/11/2020] [Accepted: 09/01/2020] [Indexed: 12/12/2022]
Abstract
LAMP2A and HSC70 are crucial players in chaperone-mediated autophagy (CMA), a targeted, lysosome-dependent protein degradation pathway. Elevated LAMP2A levels, indicative of increased CMA activity, are observed in several malignancies, and CMA downregulation may be exploited therapeutically. We evaluated the impact of LAMP2A and HSC70 in pulmonary squamous cell carcinomas (pSQCC). Antibodies were validated by knockdown and overexpression experiments using three different cell lines. Expression levels in tissue were analyzed by immunohistochemistry in a cohort of 336 consecutive pSQCC using tissue microarrays. There was no significant correlation between the two markers among each other and no association with pathological parameters (TNM categories, grading). However, both high LAMP2A and HSC70 expression were associated with worse outcome, including overall survival (OS; p = 0.012 and p = 0.001) and disease free survival (DFS; p = 0.049 and p = 0.036). In multivariate analysis, both markers and a combination of them were independent adverse prognostic factors for OS (LAMP2Ahigh: HR = 2.059; p < 0.001; HSC70high: HR = 1.987; p < 0.001; LAMP2Ahigh/HSC70high: HR = 1.529; p < 0.001) and DFS (LAMP2Ahigh: HR = 1.709; p = 0.004; HSC70high: HR = 1.484; p = 0.027; LAMP2Ahigh/HSC70high: HR = 1.342, p < 0.001). The negative prognostic impact of high LAMP2A and HSC70 and their variable expression in pSQCC may justify the use of these proteins as potential biomarkers for future CMA-inhibiting therapies.
Collapse
|
26
|
Abstract
Tumour budding is an emerging prognostic biomarker in colorectal cancer (CRC) and other solid cancers. Tumour buds are usually defined as isolated single cancer cells or clusters of up to four cancer cells located at the invasive tumour front. The prognostic value of tumour budding is now supported by a large body of evidence, whereas the utility of this phenotype as a predictive biomarker remains under investigation. The application of tumour budding indices in clinical practice requires a standardized scoring system that can be tailored to specific tumour types and clinical scenarios. In the context of CRC, tumour budding can be assessed according to the method agreed at the International Tumour Budding Consensus Conference (ITBCC) in 2016. Using the ITBCC scoring system, tumour budding is an independent predictor of lymph node metastasis in patients with pT1 CRC and of unfavourable survival in patients with stage II colon cancer. Regardless of the clinical scenario or tumour type, the assertion that 'the more tumour buds, the worse the clinical outcome' applies. In this Review, we provide an overview of tumour budding in solid cancers, highlighting the molecular and biological aspects of this phenomenon, including its associations with epithelial-mesenchymal transition and features of the tumour microenvironment. We also describe the available evidence demonstrating the value of tumour budding as a biomarker across various solid cancers.
Collapse
|
27
|
Tumour budding and its clinical implications in gastrointestinal cancers. Br J Cancer 2020; 123:700-708. [PMID: 32601463 PMCID: PMC7462864 DOI: 10.1038/s41416-020-0954-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/17/2020] [Accepted: 06/02/2020] [Indexed: 02/07/2023] Open
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.
Collapse
|