Tumor budding and evidence-based treatment of T2 rectal carcinomas

✍ Scribed by Tadahiko Masaki; Hiroyoshi Matsuoka; Masanori Sugiyama; Nobutsugu Abe; Atsuhiko Sakamoto; Toshiaki Watanabe; Hirokazu Nagawa; Yutaka Atomi

• Publisher: John Wiley and Sons
• Year: 2005
• Tongue: English
• Weight: 168 KB
• Volume: 92
• Category: Article
• ISSN: 0022-4790
• DOI: 10.1002/jso.20369

✦ Synopsis

Background:

The validity of the histological criteria in deciding additional bowel resection after local excision of t2 rectal carcinomas is questioned.

Methodology:

In 72 t2 colorectal carcinomas resected by major surgery, the associations between lymph node metastasis (lnm) and clinicopathologic parameters were examined statistically, a prediction formula for lnm was constructed and decision analysis was attempted.

Results:

Multivariate analysis showed that female gender and a greater number of tumor budding were significantly associated with lnm. the probability of lnm can be calculated as follows; z = 0.037 x (budding number) + 2.08 x (sex; male, 1; female, 2) - 5.736; probability = 1/1 + e(-z). when a 75-year-old patient has pulmonary complications, the operative risk is assumed to be over 2%. if a number of tumor budding is 0, the risk of lnm is calculated as 2.4% in a male and 17.1% in a female patient. on the assumption that the risk of liver metastasis is half of that of lnm, and the salvageabilities after lnm and liver metastasis are 20% and 50%, respectively, observation policy is justified for a male patient, whereas additional surgery should be undertaken for a female patient.

Conclusions:

A number of tumor budding may be useful for determining the individualized treatment of t2 rectal carcinomas.