Prognostic significance of tumor budding in endometrial cancer: clinicopathological insights.

Abstract

Purpose: Endometrial cancer is one of the most common gynecological cancers worldwide, with rising incidence rates. Despite therapeutic advances, it remains a significant cause of cancer-related deaths. Tumor budding (TB), characterized by single cells or small clusters at the invasive tumor front, is a recognized prognostic marker in several cancers but is less studied in endometrial cancer.

Methods: This prospective cohort study included 30 patients with endometrial cancer who underwent surgical resection from January 2022 to June 2023. Formalin-fixed, paraffin-embedded tissue blocks were reviewed by two blinded pathologists. TB at the invasive front was assessed using hematoxylin and eosin staining. Clinical and pathological parameters, including age, histological type, grade, stage, myometrial invasion, lymphovascular space invasion, and nodal involvement, were recorded. Fisher's exact and chi-square tests were used for statistical analyses.

Results: Most patients (60%) were aged 51-60 years, with 93.3% diagnosed with endometrioid adenocarcinoma. Tumors were graded as 40% grade 1, 43.3% grade 2, and 16.7% grade 3. Staging showed 36.7% FIGO IA, 36.7% IB, 16.7% II, and 10% III. TB was classified as low (70%), intermediate (23.3%), and high (6.7%). Higher TB levels were significantly associated with higher tumor grade (P=0.03), advanced stage (P=0.02), and nodal involvement (P=0.01).

Conclusion: TB correlates with adverse features in endometrial cancer, including higher grade, advanced stage, and nodal involvement. These findings underscore TB's potential as a prognostic marker, warranting validation in larger studies and exploration of its molecular basis to guide personalized treatments.