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Polish Journal of Pathology
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vol. 75
Short communication

Tumour budding in gallbladder carcinoma

Luisa F. Rivera-Moncada
Leonardo S. Lino-Silva

Medical Student, AFINES program, Medicine school, National Autonomous University of Mexico, Coyoacan, Mexico City, Mexico
Surgical Pathology, Instituto Nacional de Cancerología, Tlalpan, Mexico City, Mexico
POL J PATHOL 2024; 75 (1): 58-60
Online publish date: 2024/03/04
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Available evidence strongly suggests that tumour budding (TB), especially in the gastrointestinal tract [1], is an adverse prognostic factor that can help stratify patients into more significant risk groups than tumour-node-metastasis staging alone. Most importantly, it has the potential to guide decision-making [2]. Its presence has been associated with significantly worse outcomes in various cancers, so the assessment of budding could be critical in treatment algorithms [3]. Unfortunately, there are no studies regarding its occurrence in gallbladder cancer.
For the considerable prognostic power of TB to be fully accepted, agreed-upon criteria for its evaluation must be established to guide further research in this area and provide practicing pathologists with reporting guidelines. Although a recent consensus has been published, there is still room for optimisation [4].
We studied a series of 59 cases of gallbladder cancer. We identified a predominance in women (53 cases, 88.1%) with a median age of 62 years (range 43–83). Most of the patients had gallstones (47 cases, 79.7%), and the median CA-19.9 level was 9.32 IU/ml. 55.9% of the cases were in stage IV. In our series, only 16 cases (27.1%) had lymph nodes sampled, and only 9 patients (15.3%) had nodal metastases. Regarding histological characteristics, 16.9% of the cases were poorly differentiated, and 53 cases (88.1%) demonstrated budding, with a median of 5 (range 0–11). Similarly to the classification of TB in the colon, we found grade 1 in 29 cases (49.2%), grade 2 in 10 (16.9%), and grade 3 in 20 (33.9%). We divided our population into 2 groups, with low budding (0–4 buds/0.785 mm2) and high budding (> 5 buds/0.785 mm2) (Table I). When comparing the variables between groups, the only one associated with high budding was a higher pathological stage (pT2b). In the survival analysis, we did not identify any variables related to mortality.
Our study did not identify clinical or pathological characteristics associated with the various degrees of TB. Likewise, TB did not influence survival. Tumour budding on the invasive front has recently been suggested as a potential index of aggressiveness and poor prognosis for various types of cancer [5, 6]. An essential advantage of this index is its simplicity and reproducible measurement. It is easily adaptable to routine histopathological examination based on H and E stains without additional expensive techniques. This feature is crucial and may have therapeutic implications for patients with gallbladder carcinoma. To date, the prognostic importance of TB in gallbladder cancer has not been investigated. Our study shows no evidence that TB has prognostic significance in overall survival.
In conclusion, the only clinical characteristic of gallbladder carcinoma associated with high TB was pT2b stage; however, TB is unrelated to overall survival in this carcinoma.
The authors declare no conflict of interest.
1. Kamall GH, Ulusoy C, Nikolovski A, Kamall S. Tumour budding – an additional prognostic factor in colorectal cancer survival. Pol J Pathol 2023; 74: 36-41.
2. Berg KB, Schaeffer DF. Tumor budding as a standardized parameter in gastrointestinal carcinomas: more than just the colon. Mod Pathol 2018; 31: 862-872.
3. Koelzer VH, Langer R, Zlobec I, Lugli A. Tumor budding in upper gastrointestinal carcinomas. Front Oncol 2014; 4: 216.
4. Lugli A, Kirsch R, Ajioka Y, et al. Recommendations for reporting tumor budding in colorectal cancer based on the International Tumor Budding Consensus Conference (ITBCC) 2016. Mod Pathol 2017; 30: 1299-1311.
5. Mäkitie AA, Almangush A, Rodrigo JP, Ferlito A, Leivo I. Hallmarks of cancer: tumor budding as a sign of invasion and metastasis in head and neck cancer. Head Neck 2019; 41: 3712-3718.
6. Kale AD, Angadi PV. Tumor budding is a potential histopathological marker in the prognosis of oral squamous cell carcinoma: current status and prospects. J Oral Maxillofac Pathol 2019; 23: 318-323.
Copyright: © 2024 Polish Association of Pathologists and the Polish Branch of the International Academy of Pathology This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
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