Tumor budding as a risk factor for nodal metastasis in pT1 colorectal cancers: a meta-analysis

Rocco Cappellesso, Claudio Luchini, Nicola Veronese, Marcello Lo Mele, Erik Rosa-Rizzotto, Ennio Guido, Franca De Lazzari, Pierluigi Pilati, Fabio Farinati, Stefano Realdon, Marco Solmi, Matteo Fassan, Massimo Rugge

Research output: Contribution to journalReview articlepeer-review


Worldwide, colorectal cancer (CRC) screening programs have significantly increased the detection of submucosal (pT1) adenocarcinoma. Completion surgery may be indicated after endoscopic excision of these potentially metastasizing early cancers. However, the postsurgical prevalence of nodal implants does not exceed 15%, leading to questions concerning the clinical appropriateness of any post-endoscopy surgery. Eastern scientific societies (Japanese Society for Cancer of the Colon-Rectum, in particular) include tumor budding (TB), defined as the presence of isolated single cancer cells or clusters of fewer than 5 cancer cells at the tumor invasive front, among the variables that must be included in histologic reports. In Western countries, however, no authoritative endorsements recommend the inclusion of TB in the histology report because of the heterogeneity of definitions and measurement methods as well as its apparent poor reproducibility. To assess the prognostic value of TB in pT1 CRCs, this meta-analysis evaluated 41 studies involving a total of 10137 patients. We observed a strong association between the presence of TB and risk of nodal metastasis in pT1 CRC. In comparing TB-positive (684/2401; 28.5%) versus TB-negative (557/7736; 7.2%) patients, the prevalence of nodal disease resulted in an odds ratio value of 6.44 (95% confidence interval, 5.26-7.87; P<.0001; I2= 30%). This increased risk of regional nodal metastasis was further confirmed after accounting for potential confounders. These results support the priority of histologically reporting TB in any endoscopically removed pT1 CRC to direct more appropriate patient management.

Original languageEnglish
Pages (from-to)62-70
Number of pages9
JournalHuman Pathology
Publication statusPublished - Jul 2017


  • Adenocarcinoma
  • Biopsy
  • Cell Movement
  • Colorectal Neoplasms
  • Humans
  • Lymph Nodes
  • Lymphatic Metastasis
  • Neoplasm Invasiveness
  • Neoplasm Staging
  • Odds Ratio
  • Predictive Value of Tests
  • Risk Assessment
  • Risk Factors
  • Journal Article
  • Meta-Analysis
  • Review
  • Research Support, Non-U.S. Gov't


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