Pathomorphological analysis of budding in colorectal carcinomas

Abstract

Morbidity and mortality from colorectal cancer (CRC) remains a current problem of modern oncology. Intensive budding is an important prognostic factor for a worse clinical course of CRC and may influence clinical decision-making regarding the use of extended interventions in pT1 and stage II, according to the conclusion of the 2016 International Consensus Conference on Tumor Budding. The aim of the work is to evaluate the prognostic significance of budding depending on the clinical and morphological characteristics of colorectal carcinomas. Materials and methods. The article deals with clinical and anatomical material of 31 patients with CRC (14 women and 17 men) who were treated in the 2nd surgical department of the SE “Dnipropetrovsk Regional Clinical Hospital” in the period from 2019 to 2021. The age of the patients varied of 27–84 years old (average age – 62.3 ± 14.8 years old). A histological examination of CRC samples was carried out with an assessment of “hot areas” of the invasive front and an immunohistochemical examination with РАН CK АЕ 1/3, Ki-67, MUC2, caspase-3, β-catenin to calculate the number of tumor cell clusters. Results. In one third of the number of samples, differences were determined not only in the number of clusters, but also in the budding category when stained by routine and immunohistochemical methods. Peritumoral budding of the invasive front with category Bd3 was always accompanied by intratumoral budding of varying degrees of intensity. The analysis of the distribution of gradations of budding of colorectal carcinomas by gender, age, location, histological degree of differentiation, and the presence of metastases did not show a statistically significant difference (p > 0.05), which may indicate the independence of this factor on the prognosis of patient survival. The intensity of budding of colorectal carcinomas depending on the expression of markers Ki-67, caspase-3 and β-catenin did not show a significant difference in subgroups (p > 0.05) but showed tendencies to increase the number of budding with an increase in the proliferation index and a decrease in the activity of the proapoptotic enzyme caspase-3. Conclusions. If the number of buds on the border of categories Bd1 and Bd2, or Bd2 and Bd3, determined by the standardized method of H & E staining is doubtful, the degree of budding may be underestimated in comparison with staining by the immunohistochemical method, due to the exclusion of falsely interpreted morphological objects as tumor clusters; the most reliable immunohistochemical marker for contrast separation of buds is a cocktail of cytokeratins.