Budding (Sprouting) as a Useful Prognostic Marker in Colorectal Mucinous Carcinoma

Abstract

Purpose: Budding (sprouting) along the invasive margin is reported to be associated with high malignant potential of colorectal carcinoma. We examined the prognostic significance of budding in colorectal mucinous carcinoma. Patients and methods: Surgically resected specimens from 31 patients with colorectal mucinous carcinoma were studied. The median postoperative follow-up was 27 months. The presence of budding was examined according to Morodomi’s criteria using hematoxylin–eosin-stained sections. Results: Budding was found in 18 lesions (58%). Budding was more frequently observed in lesions with venous invasion and lymph node metastasis than in those without (P = 0.04, P = 0.03, respectively). The incidence of budding was higher in lesions with distant metastasis than in those without (P < 0.03). Overall recurrence and peritoneal disseminated recurrence were significantly more frequent in patients with budding-positive lesions than in those with budding-negative lesions (P = 0.05, P = 0.04, respectively). The cumulative 5-year survival rate of curative resected cases was lower in patients with budding-positive lesions than in those with budding-negative lesions (25.0% versus 90.9%, P = 0.01, log-rank test). Moreover, both the univariate and multivariate proportional hazard models revealed that the presence of budding was the only significant co-factor of postoperative survival. Conclusion: Budding is a pathological marker suggesting high malignant potential and decreased postoperative survival in patients with colorectal mucinous carcinoma.