Tumor budding (TB), a histopathological manifestation of epithelial–mesenchymal transition, is an important step in cancer invasion and metastasis development. TB has been considered a strong prognostic indicator in colorectal cancer. The International Tumor Budding Consensus Conference (ITBCC) scoring system is the standardized method used for patient outcome prediction in several human tumors. We investigated the clinicopathological implications and applicability of TB measured using the ITBCC scoring system in gallbladder cancer (GBC). The TB grades assigned to the 78 GBC patients were as follows: Bd1 (low TB), 41 (52.6%) patients; Bd2 (intermediate TB), 22 (28.2%) patients; and Bd3 (high TB), 15 (19.2%) patients. A higher TB grade correlated with a poorer histological differentiation (P < 0.000), higher pT category (P < 0.000), the involvement of surgical resection margin (P = 0.005), presence of nodal metastasis (P < 0.000), lymphatic and venous invasion (P < 0.000), and perineural invasion (P = 0.004). Univariate Cox regression analysis revealed that a poor histological grade, high pT category, lymphatic invasion, perineural invasion, and intermediate to high TB grades were associated with worse 5-year overall survival and disease-free survival. TB was not significantly associated with death or recurrence risk in multivariate Cox analysis. The interobserver agreement of TB grading was substantial. This study is the first to apply the ITBCC scoring system and suggest the prognostic value of TB in GBC.

肿瘤发芽（TB）是上皮-间质转化的一种组织病理学表现，是癌症侵袭和转移发展的重要步骤。结核病被认为是结直肠癌的有力预后指标。国际肿瘤萌芽共识会议（ITBCC）评分系统是用于预测几种人类肿瘤患者预后的标准化方法。我们调查了使用ITBCC评分系统在胆囊癌（GBC）中测量的TB的临床病理学意义和适用性。分配给78名GBC患者的TB等级如下：Bd1（低TB），41名（52.6％）患者；Bd2（中级结核病）22例（28.2％）；和Bd3（高结核病）患者15例（19.2％）。较高的TB等级与较差的组织学分化相关（P <0.000），更高的pT类别（P  <0.000），涉及手术切除边缘（P  = 0.005），是否存在淋巴结转移（P  <0.000），淋巴和静脉浸润（P  <0.000）和神经周浸润（P = 0.004）。单因素Cox回归分析显示，较差的5年总生存率和无病生存率与组织学等级差，pT类别高，淋巴管浸润，神经周浸润以及中级至高TB级有关。在多变量Cox分析中，TB与死亡或复发风险没有显着相关性。结核分级的观察者之间的协议是实质性的。这项研究是首次应用ITBCC评分系统并提出TB在GBC中的预后价值。