A Study on Prognostic Value of Tumor Budding in Patients with Rectal Cancer

Kazuo Hase, Hidetaka Mochizuki, Kiyohiko Koike, Eishu Nakamura, Hideki Ueno, Sachio Yokoyama, Hiroyuki Kurihara, Kazutsugu Iwamoto, Kazuyoshi Yoshimura, Tetsuhisa Yamamoto, Tsukasa Yoshizumi, Shoetsu Tamakuma

First Department of Surgery, National Defense Medical College

Two hundred ninety-seven patients who underwent rectal adenocarcinoma resection from 1978 to 1988 were studied retrospectively to evaluate the prognostic value of tumor budding. The surgical specimens were examined for histological evidence of budding, defined as small clusters of poorly differentiated or undifferentiated cancer cells ahead of the invasive front of the lesion. Patients were divided into two groups according to the degree of budding: none or mild (bd0,1) and moderate or severe (bd2,3). Of the 297 patients, bd0,1 was seen in 181 patients (61%) and bd2,3 in 116 (39%). Higher grade budding was associated with a significantly higher recurrence rate; 51% for bd2,3 patients vs 19% for bd0,1 for bd0,1 patients. The five-year cumulative survival rate was worse in bd2,3 than bd0,1 (46% vs 79%, p<0.001), and the ten-year cumulative survival rate was also worse in bd2,3 than bd0,1 (38% vs 64%, p<0.05). As might be expected, the incidence of bd2,3 rose according to Dukes's stage: namely,8% in Dukes' A, 18% in Dukes' B and 57% in Dukes' C. There was no difference in recurrence rate or cumulative survival curve between bd0,1 patients with Dukes' C and bd2,3 patients with Dukes' B. The presence of higher grade budding appears to indicate vigorous biological activity in rectal cancer. Thus, regardless of the patient's Dukes' stage, meticulous postoperative follow-up and adjuvant chemotherapy may be beneficial for patients with marked budding.

Key words
tumor budding in rectal cancer, prognosis detecting factor

Reprint requests
Kazuo Hase First Department of Surgery, National Defense Medical Collge
3-2 Namiki, Tokorozawa, 359 JAPAN

Accepted
July 6, 1992

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