Tumor budding, a novel prognostic indicator for predicting stage progression in T1 bladder cancers.
Tumor budding has been defined as an isolated single cancer cell or a cluster composed of fewer than five cancer cells scattered in the stroma. It is a strong predictor for lymph node metastasis in T1 colorectal cancer. We introduced this concept to T1 non-muscle invasive bladder cancer and evaluated whether tumor budding could have a prognostic impact on the clinical outcome. We identified 121 consecutive patients with newly diagnosed T1 bladder cancer between 1994 and 2014 at Keio University Hospital. All slides were re-reviewed by a dedicated uropathologist. Budding foci were counted under ×200 magnification. When the number of budding foci was 10 or more, tumor budding was defined as positive. The relationship between tumor budding and clinical outcomes was assessed using a multivariate analysis. The median follow-up was 52 months. Tumor budding was positive in 21 patients (17.4%). Tumor budding was significantly associated with T1 substaging, tumor architecture and lymphovascular invasion. The 5-year progression-free survival rate in T1 bladder cancer patients with tumor budding was 53.8%, which was significantly lower than that in patients without tumor budding (88.4%, P = 0.001). A multivariate Cox regression analysis revealed that tumor budding was independently associated with stage progression (P = 0.002, hazard ratio = 4.90). In a subgroup of patients treated with bacillus Calmette-Guérin instillation (n = 88), tumor budding was also independently associated with stage progression (P = 0.003, hazard ratio = 5.65). Tumor budding may be a novel indicator for predicting stage progression in T1 bladder cancer, and would likely be easily introduced in clinical practice.
Department of Urology, Keio University School of Medicine, Tokyo, Japan.
Keishiro
K
Fukumoto
Department of Urology, Keio University School of Medicine, Tokyo, Japan. eiji-k@kb3.so-net.ne.jp.
Eiji
E
Kikuchi
Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan.
Shuji
S
Mikami
Department of Urology, Keio University School of Medicine, Tokyo, Japan.
Koichiro
K
Ogihara
Department of Urology, Keio University School of Medicine, Tokyo, Japan.
Kazuhiro
K
Matsumoto
Department of Urology, Keio University School of Medicine, Tokyo, Japan.
Akira
A
Miyajima
Department of Urology, Keio University School of Medicine, Tokyo, Japan.
Mototsugu
M
Oya
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D018450:Disease Progression; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D047368:Tumor Burden; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000473:pathology*
Disease progression; pathology; recurrence; transitional cell; urinary bladder neoplasms