Budding as a useful prognostic marker in pT3 well- or moderately-differentiated rectal adenocarcinoma

Budding along the invasive margin is reported to be associated with greater malignant potential in colorectal adenocarcinoma. We examined the prognostic significance of budding in patients with pT3 rectal carcinoma, particularly in comparison to other routine pathological findings.

Surgically resected specimens from 83 well- or moderately-differentiated pT3 rectal adenocarcinomas were studied. All resections were curative (R0), and the median postoperative follow-up was 47 months. We examined the presence of budding according to Morodomi's criteria, using hematoxylin-eosin stained sections.

Budding was found in 48 patients (57.9%). The incidence of budding was significantly higher in lesions displaying lymphatic invasion and lymph-node metastasis than in those without (P < 0.0001). Both local recurrence and liver metastasis were more frequent in patients with budding-positive lesions (P < 0.002 and 0.02, respectively). Moreover, postoperative survival was significantly decreased in patients with budding-positive lesions than in those with budding-negative lesions (cumulative 5-year survival rate were 51.8 and 85.0%, respectively: P < 0.002). Multivariate proportional hazard model revealed that the presence of budding was the only significant co-factor of postoperative survival.

Budding is a pathological marker suggesting high malignant potential and decreased postoperative survival in patients with well- or moderately-differentiated pT3 rectal adenocarcinoma.