Tumor Budding, Poorly Differentiated Clusters and Desmoplastic Reaction: New Evolving Prognostic Factors in Colorectal Cancer

Background: This study aimed to evaluate the application of the new 
assessment methods of tumor budding, poorly differentiated clusters and 
desmoplastic stromal reaction at the invasive front of colorectal carcinoma, 
assess and compare their prognostic impact and detect the association between 
(TB, PDCs and DR) and other conventional pathological parameters including 
TNM stage, perineural invasion and lymphovascular invasion.
Methods: One hundred thirty-five cases of different stages of CRC with radical 
resection were included. Two pathologists independently examined 
Hematoxylin and Eosin-stained paraffin-embedded sections stained with 
Hematoxylin and Eosin according to the most recent assessment procedures for 
TB, PDC, and DR.
Result: TB scores were strongly correlated with PNI (p = 0.012), pathologic N 
stage classification (p = 0.017), PDC (p <0.001), and DR (p <0.001), suggesting 
that it may be a good predictor of lymph node metastasis. The correlation 
between PDC grades and LVI (p=0.018), PNI (p=0.002), and DR (p<0.001) was 
statistically significant. There was a strong correlation between DR types and 
tumour size (p=0.007), LVI (p=0.011), and PNI (p<0.001). The OS was 
considerably impacted by TB, PDC, and DR, but only TB stratified survival 
rates independently of the conventional TNM stage and WHO tumour grade.
Conclusion: Independent of the AJCC tumour staging criteria and other 
traditional histopathologic prognostic factors, the prognostic significance of TB 
evaluation according to the ITBCC recommendations was robust.