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3 . 2022

Tumor budding in relation to the infiltrative potential of ampullary carcinoma

Abstract

Background. The phenomenon of tumor budding (Bd), observed as the appearance of single or isolated (up to 4) clusters of tumor cells in the invasive component of carcinoma, was first described in 1954. However, only in 2016 according to ITBCC (International Consensus Conference on Tumor Budding) guidelines for estimating Bd for colorectal adenocarcinoma have been published. To date, according to numerous studies, the detection of tumor budding in colorectal cancer is a natural prognostic factor that causes overall and disease-free survival. Despite the emerging histological picture with tumors with a detected immunophenotype, to date there are only a few works on the detection of tumor budding in ampullary carcinoma.

Aim – study of the phenomenon of tumor budding in the intestinal type of ampullary carcinoma.

Material and methods. The surgical material of 36 patients aged 51 to 83 years (mean – 65 years), who underwent pancreatoduodenal or gastropancreatoduodenal resection for ampullary carcinoma was studied. The phenomenon of tumor budding was quantified according to the recommendations of the ITBCC (International Tumor Budding Consensus Conference). Correlation-regression analysis was used to assess the strength and significance of the relationship between tumor budding and the characteristics of the primary tumor, the degree of its differentiation, indicators of perineural and perivascular invasion, and indicators of regional metastasis.

Results. In 91.7% of cases (33/36), ampullary carcinoma is represented by a low-grade tumor. In 53.8% (19/36) of cases, invasion into the muscular membrane of the duodenal wall (pT2) was detected; in 44.3% of cases (16/36) the stage was defined as pT3, i.e. had an invasion of the head of the pancreas. And only in 1% of cases the tumor is limited to the ampulla of the major duodenal papilla (pT1). Damage to regional lymph nodes was noted in 50.0% (18/36) of cases and was detected both with direct and metastatic spread of carcinoma. With highly differentiated forms and micropapillary histological type of AK, in no case was the phenomenon of tumor budding detected. It was detected in 27.7% of cases (10/36) and was found in all cases of poorly differentiated forms. At the same time, for G2 tumors, the degree of Bd did not exceed 5–7 per 0.785 mm2. A high percentage of tumor budding is associated with poorly differentiated forms (p=0.0067, R=0.43). The higher the Bd value, the more often metastases were found in regional lymph nodes (p=0.0054, R=0.67, R=5.75, 95% CI: 3.20–10.32). In all cases with the presence of perineural invasion, a high percentage of tumor budding was revealed – Bd 2–3 (p=0.008, R=0.69).

Conclusion. Given the correlation between the number of tumor clusters during budding and the invasive potential of the tumor with the degree of differentiation of the primary tumor, the frequency of regional metastasis, and the presence of perineural invasion, this phenomenon should be considered as an independent prognostic factor for a worse prognosis in ampullary carcinoma, by analogy with primary tumors of the colon.

Keywords:tumor budding; ampullary carcinoma; carcinoma of the major duodenal papilla; invasive potential of the tumor

Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Eremeeva E.R., Setdikova G.R., Verbovsky A.N., Semenkov A.V., Shikina V.E. Tumor budding in relation to the infiltrative potential of ampullary carcinoma. Clinical and Experimental Surgery. Petrovsky Journal. 2022; 10 (3): 76–82. DOI: https://doi.org/10.33029/2308-1198-2022-10-3-76-82  (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)

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