Differential effect of tumor budding on the benefit of adjuvant chemotherapy in stage II colorectal cancer: a retrospective observational study.

IF 2 4区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Journal of gastrointestinal oncology Pub Date : 2024-08-31 Epub Date: 2024-08-26 DOI:10.21037/jgo-24-278

Xin Ran, Yan Chen, Chengxiang Liu, He Xiao, Xiaona Su, Zhuo Chen, Jia Du, Juan He, Peng Zhong, Mengxia Li, Nan Dai, Chuan Chen

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Abstract

Background: Tumor budding (TB) has been shown to be a poor prognostic indicator after colorectal cancer (CRC) surgery. The aim of the present study is to evaluate the predictive role of morphological features (e.g., the number, structure, and location of tumor buds, and their reaction with the extracellular mesenchyme) in postoperative adjuvant chemotherapy in surgically resectable stage II CRC.

Methods: Between 2016 and 2019, 336 patients with stage II CRC who underwent radical surgery were enrolled in this study. TB status was determined according to the criteria adopted at the 2016 International Tumor Budding Consensus Conference (ITBCC). We retrospectively recorded all the clinical and pathological data and assessed the effect of different types of TB status on patients' recurrence-free survival (RFS) and overall survival (OS).

Results: Of the 336 patients, 173, 88, and 75 were budding grade 1 (BD1), BD2, and BD3, respectively. The 5-year RFS rates were 84.6%, 81.2%, and 68.0% (P=0.01), and the 5-year OS rates were 91.0%, 83.3%, and 76.2% (P=0.007) in BD1, BD2, and BD3, respectively. TB grade was strongly associated with vascular invasion status and mucinous adenocarcinoma, and BD3 was detected in 51.7% of patients with positive vascular invasion. The multivariate analysis showed that only age, perineural invasion, and TB grade [BD2 vs. BD1, hazard ratio (HR) =1.468, 95% confidence interval (CI): 0.703-3.063, P=0.30; BD3 vs. BD1, HR =2.310, 95% CI: 1.154-4.625, P=0.01] had an independent effect on RFS. In addition, the Kaplan-Meier curve analysis showed that BD3 patients had the worst RFS (P=0.01). The OS of the adjuvant chemotherapy group was significantly improved compared to that of the surgery-only group in the BD1/2 patients (HR =0.278, 95% CI: 0.114-0.676, P=0.005) but not in the BD3 patients with significant interaction (P_interaction=0.03).

Conclusions: Our results indicate that TB could play a subsidiary role in selecting stage II CRC patients who could achieve a favorable prognosis with chemotherapy.

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肿瘤萌芽对 II 期结直肠癌辅助化疗获益的不同影响：一项回顾性观察研究。

背景：肿瘤萌芽（TB）已被证明是结直肠癌（CRC）术后预后不良的指标。本研究旨在评估形态学特征（如肿瘤芽的数量、结构、位置及其与细胞外间质的反应）在可手术切除的 II 期 CRC 术后辅助化疗中的预测作用：2016年至2019年期间，336名接受根治性手术的II期CRC患者被纳入本研究。TB状态根据2016年国际肿瘤萌芽共识会议（ITBCC）通过的标准确定。我们回顾性记录了所有临床和病理数据，并评估了不同类型的TB状态对患者无复发生存期（RFS）和总生存期（OS）的影响：336例患者中，分别有173例、88例和75例为1级（BD1）、BD2和BD3。BD1、BD2和BD3的5年RFS率分别为84.6%、81.2%和68.0%（P=0.01），5年OS率分别为91.0%、83.3%和76.2%（P=0.007）。TB分级与血管侵犯状态和粘液腺癌密切相关，51.7%的血管侵犯阳性患者检出BD3。多变量分析显示，只有年龄、神经周围侵犯和结核分级[BD2 vs. BD1，危险比（HR）=1.468，95% 置信区间（CI）：0.703-3.063，P=0.30；BD3 vs. BD1，HR =2.310，95% CI：1.154-4.625，P=0.01]对RFS有独立影响。此外，Kaplan-Meier曲线分析显示，BD3患者的RFS最差（P=0.01）。在BD1/2患者中，辅助化疗组的OS与单纯手术组相比有明显改善（HR=0.278，95% CI：0.114-0.676，P=0.005），但在BD3患者中没有明显的交互作用（Pinteraction=0.03）：我们的研究结果表明，肺结核在选择可通过化疗获得良好预后的 II 期 CRC 患者方面可发挥辅助作用。

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来源期刊

Journal of gastrointestinal oncology Medicine-Oncology

CiteScore

3.20

自引率

0.00%

发文量

171

期刊介绍： ournal of Gastrointestinal Oncology (Print ISSN 2078-6891; Online ISSN 2219-679X; J Gastrointest Oncol; JGO), the official journal of Society for Gastrointestinal Oncology (SGO), is an open-access, international peer-reviewed journal. It is published quarterly (Sep. 2010- Dec. 2013), bimonthly (Feb. 2014 -) and openly distributed worldwide. JGO publishes manuscripts that focus on updated and practical information about diagnosis, prevention and clinical investigations of gastrointestinal cancer treatment. Specific areas of interest include, but not limited to, multimodality therapy, markers, imaging and tumor biology.