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Analysis of tumor budding as a prognostic factor for recurrence in patients with stage II and III colon cancer. Experience in a tertiary hospital.

Publicated to:ONCOLOGIST. 30 (3): oyaf027- - 2025-03-10 30(3), DOI: 10.1093/oncolo/oyaf027

Authors: Rueda-Lara A; Viñal D; Martínez-Pérez D; Alameda-Guijarro M; Martin-Montalvo G; Martínez-Recio S; Peña-Lopez J; Jiménez-Bou D; Ruíz-Gutiérrez I; García-Leal A; Zwisler-Contreras P; Ghanem I; Custodio AB; Pérez-Wert P; Gutiérrez-Sainz L; Palacios ME; Feliu J; Rodríguez-Salas N

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Abstract

Stage II and III colorectal cancer (CRC) poses a significant challenge due to rising global incidence and mortality rates. Despite advancements in screening and treatment, there's a pressing need for reliable prognostic biomarkers. Tumor budding emerges as a promising marker associated with poor prognosis and higher recurrence. However, its incorporation into clinical guidelines differs when considering adjuvant treatment. This study assesses tumor budding's prognostic value for recurrence in stage II and III CRC, exploring its implications for risk stratification. This retrospective study encompassed patients with stage II-III CRC at Hospital Universitario La Paz from October 2016 to January 2022. Tumor budding was assessed according to the 2016 ITBCC guidelines and categorized as low, intermediate, or high. The primary outcomes, time to recurrence (TTR) and overall survival (OS), were analyzed using Kaplan-Meier and Cox regression models. A total of 390 patients were included in the final analysis. They were predominantly male (55%) with an average age of 75 years (range 35-95). Fifty percent of patients were stage II. Tumor budding was categorized as low, intermediate, and high in 186 (48%), 110 (28%), and 94 (24%) patients, respectively. After a median follow-up of 46.1 months, there were 71 recurrences and 96 deaths. Time to recurrence (TTR) was significantly shorter for patients with high tumor budding. At 24 months, freedom from recurrence was 92%, 84%, and 69% for low, intermediate, and high tumor budding groups, respectively. Median TTR was not reached in any group. Multivariate analysis revealed high-grade budding as an independent predictor of recurrence with a hazard ratio (HR) of 2.39 (P = .01; 95% CI, [1.42-4.04]). Our study highlights the prognostic value of tumor budding in predicting recurrence in both stage II and III colorectal cancer patients, reinforcing its potential as an important biomarker beyond stage II CRC.

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