Background and study aims

Tumour budding (TB) at the invasive front, termed peritumoural budding (PTB), is an established prognostic factor for many solid tumours. However, intratumoural budding (ITB) in gastric adenocarcinoma (GAC), which is frequently observed at the tumour centre, particularly in tumour biopsy tissues, remains poorly understood. Hence, we aimed to determine the correlation of ITB with PTB and their connection with clinicopathological characteristics as well as their prognostic value in GAC.

Patients and methods

We investigated a total of 153 cases of GAC wherein tissues were primarily resected and their related clinicopathological data. A continuous series of paraffin-embedded tissues was stained by haematoxylin–eosin staining, and budding cells were identified by immunohistochemical staining. PTB and ITB were counted in five fields with the highest density of tumour buds. The selected area was examined under 40 high-power field. Cases were divided into low-grade TB and high-grade TB groups according to the median bud count.

Results

Among the 153 patients with GAC, 51 underwent simultaneous observation of ITB and PTB, which were found to have a significant positive correlation. A higher grade of ITB in tumours was associated with positive lymph node metastasis and could predict a worse prognosis. Additionally, patients with simultaneous PTB and ITB had a shorter overall survival than those with PTB alone, suggesting a worse prognosis.

Conclusion

PTB and ITB were found to be adverse prognostic factors and high-risk indicators of intestinal-type GAC, and ITB plays an important role in evaluating GAC prognosis in gastroscopic biopsy tissues. Additionally, TB might become a useful index for predicting GAC prognosis in the future.

中文翻译：

---

肠型胃腺癌的肿瘤周围和肿瘤内萌芽的预后意义。

背景和学习目的

浸润前部的肿瘤萌发（TB），称为肿瘤周围萌芽（PTB），是许多实体瘤的既定预后因素。然而，胃腺癌（GAC）中的肿瘤内出芽（ITB）经常在肿瘤中心，尤其是在肿瘤活检组织中观察到，仍然知之甚少。因此，我们旨在确定ITB与PTB的相关性及其与临床病理特征的联系，以及它们在GAC中的预后价值。

患者和方法

我们调查了总共153例GAC患者，其中主要切除了组织及其相关的临床病理数据。用苏木精-曙红染色对连续一系列石蜡包埋的组织进行染色，并通过免疫组织化学染色鉴定出芽细胞。PTB和ITB在五个具有最高肿瘤芽密度的区域中计数。所选区域在40个大功率场下进行了检查。根据中位芽数将病例分为低度结核病组和高度结核病组。

结果

在153例GAC患者中，有51例同时进行了ITB和PTB的观察，发现两者之间存在显着的正相关。肿瘤中较高水平的ITB与阳性淋巴结转移有关，并可能预示不良预后。此外，同时存在PTB和ITB的患者的总生存期比单纯PTB的患者要短，预后较差。

结论

发现PTB和ITB是肠型GAC的不良预后因素和高风险指标，而ITB在评估胃镜活检组织中的GAC预后中起着重要作用。此外，结核病可能会成为将来预测GAC预后的有用指标。