Tumor Budding Is an Independent Prognostic Parameter in Ampullary Adenocarcinomas
I Coban, N Ohike, G Kim, T Morohoshi, A Krasinskas, O Basturk, S Bandyopadhyay, M Goodman, NV Adsay. Emory, GA; UCSF, CA; Showa, Tokyo, Japan; U of Pittsburg, PA; NYU, NY; WSU, Detroid
Background: Tumor budding (BUD) confers a worse prognosis and correlates significantly with nodal metastasis in colorectal cancer but has not been evaluated in ampullary adenocarcinoma (AAC).
Design: 244 surgically resected stringently defined invasive AAC were analyzed for BUD, defined as an isolated single cell or a cluster composed of <5 cells. The presence of any focus with >5 BUDs per 20X (0.785 mm2) was considered as “positive”, and if there were >3 BUD-“positive” foci, the case was regarded as BUD-high. Accordingly, BUD-negative cases and those with <3 BUD-positive foci were regarded as BUD-low.
Results: 194 AAC cases were BUD-high, and 50 were BUD-low (29 with 1-2 positive foci, and 21 negative). BUD-high cases correlated significantly with non-intestinal type histology, higher lymph node metastasis, higher T-stage tumors, and more aggressive behavior. Furthermore, in stepwise multivariable Cox regression model, tumor budding was found to be an independent predictor of survival (p=0.0051), impacting prognosis (hazards ratio of 2.9) more than that of T-stage and LN metastasis (2.0 and 1.9, respectively).
Conclusions: Tumor budding is frequently encountered in ACC. High budding is a strong independent predictor of overall survival, with a prognostic correlation stronger than established parameters of T-stage and lymph node metastasis. Therefore, budding should be incorporated into surgical pathology reports for AAC.
Category: Liver & Pancreas
Tuesday, March 23, 2010 1:00 PM
Poster Session IV # 194, Tuesday Afternoon