Budding is useful to select high-risk patients in Stage II well-differentiated or moderately differentiated colon adenocarcinoma

PURPOSE: Budding at the invasive front of tumors has recently been thought to suggest greater malignant potential of the colorectal carcinoma. We examined whether budding is associated with poor prognosis after curative resection in Stage II and Stage III colon carcinoma. Furthermore, we examined whether budding is useful to select high-risk patients in Stage II colon carcinoma. METHODS: Surgically resected specimens of 196 Stage 11 and Stage III colon carcinomas were studied. All the resections were curative (110), and the median postoperative follow-up was 75.5 months. Using hematoxylin-eosin-stained sections, we determined the presence or absence of budding according to Morodomi's criteria. Routine pathologic findings were also recorded. RESULTS: Budding was detected significantly more frequently in lesions with lymph node metastasis (Stage 111) than in lesions without it (Stage 11; P < 0.0001). Patients with budding-positive lesions had worse outcome than those with budding-negative lesions: 43 patients (50.6 percent) with budding-positive lesions and 9 (8.1 percent) with budding-negative lesions developed recurrence (P < 0.0001). Patients with budding-positive lesions had a worse prognosis than patients without it (P < 0.0001). Moreover, no significant difference in survival curves was observed between patients with budding-positive Stage 11 lesions and those with Stage III lesions (P = 0.930). Multivariate analysis revealed budding as the significant prognostic cofactor of postoperative survival in Stage 11 and Stage III colon carcinoma (P < 0.0001). CONCLUSION: Budding is useful to select high-risk patients in Stage 11 colon carcinoma.