title: Tumor budding and evidence-based treatment of T2 rectal carcinomas.
abstract: 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.
authors.affiliation: Department of Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka city, Tokyo, Japan. masaki@kyorin-u.ac.jp
authors.forename: Tadahiko
authors.initials: T
authors.lastname: Masaki
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Matsuoka
authors.forename: Masanori
authors.initials: M
authors.lastname: Sugiyama
authors.forename: Nobutsugu
authors.initials: N
authors.lastname: Abe
authors.forename: Atsuhiko
authors.initials: A
authors.lastname: Sakamoto
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Watanabe
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Nagawa
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Atomi
mesh_terms: 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