Authors
Yao Shu, Heng Zhang, Alessandro Lugli, Femke Simmer, Iris D Nagtegaal
Published in
Histopathology. Jun 20, 2026. Epub Jun 20, 2026.
Abstract
Tumour budding (TB) has been recognized as an additional prognostic factor in the TNM (2017) and WHO (2019) classification systems. However, its prognostic impact in stages II and III colorectal cancer (CRC) remains inconsistently defined. This study aims to systematically evaluate the prognostic value of high-grade TB in stage II-III CRC.
A systematic search of PubMed, Embase and Cochrane Library was conducted to identify studies reporting the association between high-grade TB and survival outcomes in stage II-III CRC. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) for disease-free survival (DFS), overall survival (OS) and cancer-specific survival (CSS) were calculated using random-effects models. A total of 43 studies involving 17,831 patients were included. Univariable analysis showed that high-grade TB was significantly associated with worse DFS (HR 2.53, 95% CI 2.14-3.00), OS (HR 2.40, 95% CI 1.69-3.42) and CSS (HR 3.37, 95% CI 2.19-5.19). Multivariable analysis confirmed the independent prognostic value of high-grade TB for all three outcomes. Subgroup analysis stratified by TNM stage revealed that high-grade TB consistently predicted adverse outcomes in both stage II and stage III disease.
This study confirms that high-grade TB is an independent prognostic factor in stage II-III CRC, consistently associated with worse DFS, OS and CSS. Incorporating TB into routine histopathological assessment may improve risk stratification and help identify high-risk patients, although its role in guiding therapeutic decisions requires further prospective validation.
PMID:
42322147
Bibliographic data and abstract were imported from PubMed on 20 Jun 2026.
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