title: Tumor budding is a significant indicator of a poor prognosis in lung             squamous cell carcinoma patients.
abstract: Lung cancer is a leading cause of cancer mortality worldwide and patients             occasionally develop local recurrence or distant metastasis soon after curative             resection. Reports of new therapeutic strategies for lung squamous cell carcinoma             (SqCC) are extremely rare, while selective anticancer therapy has been reported             for lung adenocarcinoma. The aim of this study was to identify clinicopathological             prognostic factors for SqCC. We analyzed tumor budding and infiltrative patterns             (INF) in 103 cases of surgically-resected SqCC. Tumor infiltrative patterns were             classified into three groups (INFa, b and c) and INFc was infiltrative growth             at the tumor invasive front. The cases with an INFc component [INFc(+)]were significantly             associated with venous invasion (P=0.014) and the scirrhous stromal type (P<0.001).             The overall survival rate of patients with INFc(+) was significantly lower than             that of patients without the INFc component [INFc(-); P=0.003]. Tumor budding             was defined as a single cancer cell or a small nest of up to four cancer cells             within stromal tissue. The cases with tumor budding [Bud(+)] were significantly             associated with lymph node metastasis (P=0.001), lymphatic invasion (P=0.002),             INFc(+) (P<0.001) and the scirrhous stromal type (P=0.014). Patients with the             Bud(+) type had a lower overall survival rate than patients with the Bud(-) type             (P<0.001). Multivariate analysis demonstrated that tumor budding [hazard ratio             (HR), 2.766; 95% confidence interval (CI), 1.497-5.109] and lymph node metastasis             (HR, 1.937; 95% CI, 1.097-3.419) were independent predictors of mortality. In             conclusion, tumor budding is a significant indicator of a high malignant potential             and poor prognosis in SqCC of the lung.
authors.affiliation: Department of General Thoracic Surgery, Tokai University School                     of Medicine, Isehara, Kanagawa 259-1193, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Masuda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kijima
authors.forename: Naoko
authors.initials: N
authors.lastname: Imamura
authors.forename: Naohiro
authors.initials: N
authors.lastname: Aruga
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Daisuke
authors.initials: D
authors.lastname: Masuda
authors.forename: Haruka
authors.initials: H
authors.lastname: Takeichi
authors.forename: Nobusuke
authors.initials: N
authors.lastname: Kato
authors.forename: Tomoki
authors.initials: T
authors.lastname: Nakagawa
authors.forename: Makiko
authors.initials: M
authors.lastname: Tanaka
authors.forename: Sadaki
authors.initials: S
authors.lastname: Inokuchi
authors.forename: Masayuki
authors.initials: M
authors.lastname: Iwazaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D011379:Prognosis; D016016:Proportional Hazards Models; D015996:Survival Rate