title: Prognostic and diagnostic significance of tumor budding associated with β-catenin expression in submucosal invasive colorectal carcinoma.
abstract: Endoscopic resection has become a major curative treatment for early colorectal carcinoma without lymph node metastasis.  However, lymph node metastasis, a poor prognostic factor in colorectal carcinoma, occurs in about 10% of the patients with submucosal invasive colorectal carcinoma.  Therefore, it is important to identify a high-risk factor for lymph node metastasis in submucosal invasive colorectal carcinoma.  This study was designed to identify the relationship between tumor budding with β-catenin expression and lymph node metastasis in submucosal invasive colorectal carcinoma.  We investigated the immunohistochemistry of tumor budding in the 142 patients who underwent surgical resection for submucosal invasive colorectal carcinomas between 1984 and 1999 and the expression pattern of β-catenin in budding tumor cells.  Accordingly, all the patients were followed up for at least 10 years or until death.  Among the 142 patients, lymph node metastasis was detected in 14 patients (9.9%).  Univariate analysis showed that tumor budding with ≥ 5 tumor cells or cell clusters with expression of β-catenin in the nucleus was significantly associated with lymph node metastasis (P = 0.005).  In contrast, tumor budding detected by hematoxylin and eosin staining was not associated with lymph node metastasis.  Multivariate logistic regression analysis showed that tumor budding with ≥ 5 tumor cells or cell clusters with expression of β-catenin in the nucleus was a significant risk factor for lymph node metastasis (odds ratio, 7.124; 95% confidence interval, 1.407-36.062).  Thus, tumor budding associated with β-catenin expression is a risk factor for lymph node metastasis in submucosal invasive colorectal carcinoma.
authors.affiliation: Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan. umekun@nyc.odn.ne.jp
authors.forename: Ken
authors.initials: K
authors.lastname: Umemura
authors.forename: Sho
authors.initials: S
authors.lastname: Takagi
authors.forename: Takenobu
authors.initials: T
authors.lastname: Shimada
authors.forename: Takayuki
authors.initials: T
authors.lastname: Masuda
authors.forename: Hisashi
authors.initials: H
authors.lastname: Shiga
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Takahashi
authors.forename: Seiichi
authors.initials: S
authors.lastname: Takahashi
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kinouchi
authors.forename: Daisuke
authors.initials: D
authors.lastname: Shibuya
authors.forename: Tooru
authors.initials: T
authors.lastname: Shimosegawa
mesh_terms: D014408:Biomarkers, Tumor / Q000378:metabolism; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D007413:Intestinal Mucosa / Q000473:pathology*; D016015:Logistic Models; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D009361:Neoplasm Invasiveness / Q000473:pathology*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D051176:beta Catenin / Q000378:metabolism*
chemical_list: D014408:Biomarkers, Tumor; D051176:beta Catenin