Journal
CANCERS
Volume 13, Issue 14, Pages -Publisher
MDPI
DOI: 10.3390/cancers13143405
Keywords
tumor budding; modified tumor budding; early gastric cancer; lymph node metastasis; endoscopic resection; surgical indication; assessment method
Categories
Funding
- Basic Science Research Program through the National Research Foundation of Korea (NRF) - Ministry of Education [2021R1I1A1A01060037]
- National Research Foundation of Korea [2021R1I1A1A01060037] Funding Source: Korea Institute of Science & Technology Information (KISTI), National Science & Technology Information Service (NTIS)
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The study demonstrates that modified tumor budding (mTB) is a more accurate predictor of lymph node metastasis (LNM) in early gastric cancer patients compared to conventional tumor budding (TB). It enhances the predictive power of LNM, providing important information for patient treatment.
Simple Summary To obtain the optimal treatment effect of endoscopic resection (ER) in early gastric carcinoma (EGC), a well-established indication for post-ER surgery is needed. In addition, accurate prediction of lymph node metastasis (LNM) is necessary to achieve this goal. Here, we present modified tumor budding (mTB), which excludes signet ring cells from conventional tumor budding (TB) as a novel predictor for LNM. Conventional TB and mTB were the most predictive independent factors for LNM. Furthermore, mTB was superior to TB in predicting LNM (p = 0.0004-0.0008). In conclusion, mTB significantly enhanced the predictive power of LNM, which could be a novel indicator for determining post-ER surgery. Endoscopic resection (ER) is a minimally invasive treatment for early gastric cancer (EGC) with a low risk of lymph node metastasis (LNM). Recently, tumor budding (TB) has emerged as a potential predictor of LNM in EGC. We assessed the clinical significance of modified TB (mTB) that excludes the signet ring cell component and compared several TB assessment methods. Two hundred and eighty-nine patients with EGC at Uijeongbu St. Mary's Hospital from 2010 to 2021 were enrolled. In univariate analysis, age, size, depth of invasion, tumor type, histologic type, Lauren classification, lymphatic invasion, venous invasion, poorly differentiated carcinoma (not otherwise specified predominant), and TB were significantly associated with LNM. Multivariate regression analysis showed that mTB (difference area under the curve [dAUC] = 0.085 and 0.087) was superior to TB (dAUC = 0.054 and 0.057) in predicting LNM. In addition, total TB counts on representative slide sections (dAUC = 0.087 and 0.057) in assessing TB and mTB and the ITBCC method (dAUC = 0.085) in mTB were superior to the presence or absence method (dAUC = 0.042 and 0.029). The mTB significantly increases LNM prediction ability, which can provide important information for patients with EGC.
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