Clinicopathologic and Prognostic Significance of Tumor Budding in Endometrial Cancer: A Systematic Review and...

Although tumor budding has emerged as an indicator of tumor aggressiveness in several solid cancers, its prognostic significance in endometrial cancer is not well studied. This systematic review and meta-analysis aimed to quantify the association between tumor budding and clinicopathologic parameters in endometrial cancer. A comprehensive search of electronic databases was performed from inception to December 2025, and clinicopathologic data were extracted from studies that included patients with histologically confirmed endometrial cancer, assessed tumor budding on histopathology, reported clinicopathologic outcomes and/or survival outcomes, and provided effect estimates or sufficient data to calculate odds ratios or hazard ratios. In the pooled analysis of data from 12 eligible studies, tumor budding was found to be significantly associated with lymphovascular space invasion, lymph node metastasis, high tumor grade and deep myometrial invasion ≥50% but not with advanced-stage disease at presentation and cervical stromal invasion. To conclude, though tumor budding is significantly associated with adverse clinicopathologic features in endometrial carcinoma, standardization of assessment methods and prospective validation are needed before routine clinical implementation as a predictive tool.