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Tumor budding as a predictive marker for 5-fluorouracil response in adjuvant-treated stage III colorectal cancer

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Abstract

Background

Tumor budding (TB) has been described as an adverse prognostic marker for operable colorectal cancer (CRC); however, a limited number of studies have demonstrated the prognostic significance of TB in patients with drug therapy. This study was conducted to determine the predictive power of TB in stage III CRC patients who received adjuvant chemotherapy.

Methods

We retrospectively collected clinicopathological data including TB of 237 stage III colorectal cancer patients at Hiroshima University Hospital between July 1, 2006 and June 31, 2019. Differential disease-free survival (DFS) was investigated according to TB status.

Results

This study included 237 patients with a median age of 67 years, comprising patients who underwent surgery alone (n = 65), 5-fluorouracil (5-FU) monotherapy (n = 129), and oxaliplatin-based chemotherapy (n = 43). Overall, 81 patients developed disease recurrence, and 33 patients died of cancer-related causes. The TB status was categorized into two groups: 99 with low budding (< 5 buds) and 138 with high budding (≥ 5 buds). Overall, the low budding cases demonstrated significantly better DFS. In the 5-FU monotherapy group, low-risk patients (T1, T2, or T3 and N1) with low budding showed a remarkably higher 3-year DFS (91%) compared to high budding (55%).

Conclusion

Our results indicate that TB could play a subsidiary role in selecting patients who could maintain a favorable prognosis with 5-FU monotherapy in stage III CRC.

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Acknowledgements

The authors thank Hisaaki Yoshinaka, Kosuke Ono, Keiso Matsubara and Tetsuya Mochizuki for supporting the medical care and data acquisition.

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Authors and Affiliations

  1. Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Shintaro Akabane, Wataru Shimizu, Yuji Takakura, Masatoshi Kochi, Kazuhiro Taguchi, Ikki Nakashima, Koki Sato, Hiroyuki Egi & Hideki Ohdan

  2. Center for Medical Education, School of Medicine, Hiroshima University, Hiroshima, Japan

    Minoru Hattori

  3. Department of Molecular Pathology, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan

    Kazuhiro Sentani & Wataru Yasui

Authors
  1. Shintaro Akabane
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  2. Wataru Shimizu
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  3. Yuji Takakura
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  4. Masatoshi Kochi
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  5. Kazuhiro Taguchi
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  8. Minoru Hattori
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  9. Hiroyuki Egi
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  11. Wataru Yasui
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  12. Hideki Ohdan
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Contributions

SA, WS, YT and HO: designed the study. SA: drafted the manuscript. WS, YT and HE: edited the manuscript. MK, KT, IN and KS: participated in the data acquisition. SA, KS and WY: performed the pathological examination. MH: participated in the statistical work. MH, KS, WY and HO: provided critical revision for the manuscript. All of the authors read and approved the final manuscript.

Corresponding author

Correspondence to Wataru Shimizu.

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Akabane, S., Shimizu, W., Takakura, Y. et al. Tumor budding as a predictive marker for 5-fluorouracil response in adjuvant-treated stage III colorectal cancer. Int J Clin Oncol 26, 1285–1292 (2021). https://doi.org/10.1007/s10147-021-01917-9

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  • DOI: https://doi.org/10.1007/s10147-021-01917-9

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