title: Actual number of tumor budding as a new tool for the individualization of treatment of T1 colorectal carcinomas.
abstract: OBJECTIVE
  Treatment of T1 colorectal carcinomas, either local excision including endoscopic polypectomy or radical surgery, has always been problematic in everyday practice. Although previous studies have revealed that tumor budding at the invasive margin can be a marker for the malignant potential of T1 colorectal carcinomas, the evaluation of tumor budding has not been standardized as yet. In the present study, we attempted to apply the actual number of tumor budding units for the individualization of treatment in T1 colorectal carcinomas.
  
  
  METHODS
  In 76 T1 colorectal carcinomas, associations between lymph node metastasis and clinicopathological parameters were examined statistically. A mathematical formula for predicting the risk of lymph node metastasis was constructed and decision analysis was attempted to determine individually the indication for additional surgery after endoscopic mucosal resection of T1 colorectal carcinomas.
  
  
  RESULTS
  Of the clinicopathological parameters examined, multivariate analysis showed that the actual number of tumor budding units alone was significantly associated with lymph node metastasis. The probability of lymph node metastasis was calculated as Z = 0.07 x (budding counts) - 3.726, probability = 1/1 + e(-Z). The more the budding counts, the higher the probability of lymph node metastasis. This formula was able to accurately predict lymph node metastasis in successive cases. The actual number of tumor budding units can be applied to decision analysis in determining an indication for additional surgery after endoscopic mucosal resection of T1 colorectal carcinomas.
  
  
  CONCLUSIONS
  The actual number of tumor budding units may be useful in the decision making for patient-oriented treatment of T1 colorectal carcinomas.
authors.affiliation: Department of Surgery, Kyorin University, 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: Yutaka
authors.initials: Y
authors.lastname: Atomi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D003082:Colectomy / Q000379:methods*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies