Abstract
In this retrospective study, we analyzed the association between tumor budding and perineural invasion as well as their prognostic role in pancreatic ductal adenocarcinoma. A total of N = 119 patients resected for pancreatic ductal carcinoma from 1996 to 2015 were included. Clinical and standard histopathological parameters were retrieved from the patient’s records. One representative hematoxylin and eosin section from the tumor region was examined for perineural invasion and tumor budding using light microscopy. Tumor budding was assessed independently using two different methods: in the first approach, the number of buds was counted over three fields of 0.237 mm2 at 40-fold magnification; in the second approach, tumor budding was quantified according to the recommendation of the International Tumor Budding Consensus Conference (ITBCC) over a field of 0.785 mm2 at 20-fold magnification. Linear and logistic regression was applied to delineate association between perineural invasion, tumor budding, and other parameters; Kaplan-Meier and Cox regression were used in the survival analysis. Regardless of the quantification approach, high tumor budding was a significant negative prognostic factor in the univariable Cox regression (> 5 buds/0.237 mm2, hazard ratio (HR) 1.66, 95% confidence interval (CI) 1.06–2.61, p = 0.027; ≥ 10 buds/0.785 mm2, HR 1.68, 95% CI 1.07–2.64, p = 0.024). In the multivariable model adjusting for stage and standard histopathological parameters, lymph vessel invasion (HR = 2.43, 95% CI 1.47–4.03, p = 0.001) and tumor budding > 5 buds/0.237 mm2 (HR = 1.70, 95% CI 1.07–2.7, p = 0.026) were independent negative prognostic factors, while adjuvant therapy was a positive prognostic factor (HR = 0.54, 95% CI 0.33–0.86, p = 0.009). No significant prognostic value could be delineated for perineural invasion. In conclusion, tumor budding is an independent negative prognostic factor in pancreatic ductal adenocarcinoma associated with lymph node metastasis. The prognostic role of perineural invasion remains uncertain.
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E Petrova integrated the data, performed the statistical analysis, and wrote the manuscript; V Zielinski performed histological analysis and drafted the manuscript; C Schreiber and S Perner acquired data from histopathological records and revised the manuscript; J Knief and C Thorns performed histological analysis and revised the manuscript; L Bolm, D Bausch, and T Keck acquired clinical data and revised the manuscript; S Timme-Bronsert, P Brosert, and U Wellner conceived and designed the study, and revised the manuscript. All authors approved the final manuscript for submission. U Wellner takes full responsibility for the work as a whole, including the study design, access to data, and the decision to submit and publish the manuscript.
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This study was conducted with the approval of the ethics committee of the University of Lübeck, Germany (Reference number 17-118A).
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Petrova, E., Zielinski, V., Bolm, L. et al. Tumor budding as a prognostic factor in pancreatic ductal adenocarcinoma. Virchows Arch 476, 561–568 (2020). https://doi.org/10.1007/s00428-019-02719-1
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DOI: https://doi.org/10.1007/s00428-019-02719-1