University of Oulu

Kemi, N., Eskuri, M., Ikäläinen, J., Karttunen, T., Kauppila, J., Tumor budding and prognosis in gastric adenocarcinoma, The American Journal of Surgical Pathology, 2019, Vol. 43:2, p. 229-234, ISSN: 0147-5185, DOI: 10.1097/PAS.0000000000001181

Tumor budding and prognosis in gastric adenocarcinoma

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Author: Kemi, Niko1; Eskuri, Maarit1; Ikäläinen, Julia1;
Organizations: 1Cancer and Translational Medicine Research Unit, Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
2Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
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Language: English
Published: Wolters Kluwer, 2019
Publish Date: 2020-02-01


Tumor budding has been associated with poor prognosis in several cancer types, but its significance in gastric cancer is unknown. The aim of this study was to assess the prognostic significance of tumor budding in gastric adenocarcinoma, and its main histologic types. Some 583 gastric adenocarcinoma patients who underwent surgery in Oulu University Hospital during the years 1983–2016 were included in this retrospective cohort study. Tumor budding was counted per 0.785 mm² fields from the slides originally used for diagnostic purposes. Patients were divided into low-budding (<10 buds) and high-budding (≥10 buds) groups. Tumor budding was analyzed in relation to 5-year survival and overall survival. Cox regression was used to calculate hazard ratios (HR) with 95% confidence intervals (CI), adjusted for confounders. Determining tumor budding was difficult in diffuse-type cancer due to the uncohesive growth pattern of these tumors. Patients with high tumor budding had worse 5-year survival compared with patients with low tumor budding (adjusted HR, 1.55; 95% CI, 1.20–2.01). In intestinal-type adenocarcinomas, the high-budding group had significantly poorer 5-year survival compared with the low-budding group (adjusted HR, 1.57; 95% CI, 1.14–2.15). There were no differences in 5-year survival between the budding groups in the diffuse type adenocarcinoma. In conclusion, high tumor budding is an independent prognostic factor in gastric adenocarcinoma, but its value is limited to the intestinal type of gastric adenocarcinoma. In diffuse type gastric adenocarcinoma, the assessment of tumor budding is hardly feasible, and it does not have prognostic relevance.

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Series: The American journal of surgical pathology
ISSN: 0147-5185
ISSN-E: 1532-0979
ISSN-L: 0147-5185
Volume: 43
Issue: 2
Pages: 229 - 234
DOI: 10.1097/PAS.0000000000001181
Type of Publication: A1 Journal article – refereed
Field of Science: 3122 Cancers
Copyright information: © 2019 Wolters Kluwer Health, Inc. All rights reserved. This is an Accepted Manuscript of an article published in The American Journal of Surgical Pathology. The Definitive Version of Record can be found online at: