Tumor budding and evidence-based treatment of T2 rectal carcinomas.
BACKGROUND
The validity of the histological criteria in deciding additional bowel resection after local excision of T2 rectal carcinomas is questioned.


METHODS
In 72 T2 colorectal carcinomas resected by major surgery, the associations between lymph node metastasis (LNM) and clinicopathologic parameters were examined statistically, a prediction formula for LNM was constructed and decision analysis was attempted.


RESULTS
Multivariate analysis showed that female gender and a greater number of tumor budding were significantly associated with LNM. The probability of LNM can be calculated as follows; Z = 0.037 x (budding number) + 2.08 x (SEX; male, 1; female, 2) - 5.736; Probability = 1/1 + e(-Z). When a 75-year-old patient has pulmonary complications, the operative risk is assumed to be over 2%. If a number of tumor budding is 0, the risk of LNM is calculated as 2.4% in a male and 17.1% in a female patient. On the assumption that the risk of liver metastasis is half of that of LNM, and the salvageabilities after LNM and liver metastasis are 20% and 50%, respectively, observation policy is justified for a male patient, whereas additional surgery should be undertaken for a female patient.


CONCLUSIONS
A number of tumor budding may be useful for determining the individualized treatment of T2 rectal carcinomas.
Masaki
Tadahiko
T
Department of Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka city, Tokyo, Japan. masaki@kyorin-u.ac.jp
Matsuoka
Hiroyoshi
H
Sugiyama
Masanori
M
Abe
Nobutsugu
N
Sakamoto
Atsuhiko
A
Watanabe
Toshiaki
T
Nagawa
Hirokazu
H
Atomi
Yutaka
Y
D002454:Cell Differentiation; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery; D012044:Regression Analysis; D012307:Risk Factors; D012737:Sex Factors; D015996:Survival Rate