Patients with high tumor budding in head and neck squamous cell carcinoma had a 5-year overall survival rate of 26%, compared with 85% for those with low tumor budding, according to a study of 98 patients. Tumor budding—small clusters of tumor cells at the invasive edge—was also linked to a higher risk of neck lymph node metastasis.
High tumor budding (>4 buds) was linked to worse outcomes overall. Nearly two-thirds of patients developed lymph node metastasis, compared with about one-third of those with low tumor budding.
Tumor budding was assessed using hematoxylin and eosin–stained surgical sections. Researchers identified 4.5 buds as the optimal cutoff using receiver operating characteristic analysis, which yielded a 77% sensitivity and 79% specificity for predicting 5-year survival.
In multivariate analysis, tumor budding remained an independent predictor of overall survival and lymph node metastasis. Patients with high tumor budding had more than a threefold higher risk of death and nearly a fivefold greater likelihood of lymph node spread.
High tumor budding also correlated with aggressive tumor features, including lymphovascular invasion and extranodal extension. Lymphovascular invasion occurred in 53% of high tumor budding cases and 28% of low cases. Extranodal extension was observed in 50% of high tumor budding patients and 8% of those with low tumor budding.
In a subgroup analysis of 76 patients with laryngeal or oral cavity cancer, high tumor budding continued to predict poorer outcomes. In this group, a 3.5 bud cutoff was used. High tumor budding was linked to more than a sixfold higher risk of death and a more than sevenfold greater likelihood of lymph node spread.
Tumor budding was not significantly associated with disease-free survival in multivariate models. In both the full cohort and laryngeal subgroup, no clinicopathologic factors, including tumor budding, were independently associated with time to recurrence.
The study included patients diagnosed between 2013 and 2022 who had confirmed head and neck squamous cell carcinoma and were treated with primary surgery and neck dissection. Patients with non-squamous tumors, incomplete records, prior treatment, or recurrent disease were excluded. The researchers reported that tumor budding alone increased the risk of lymph node metastasis to the neck by fourfold.
Researchers concluded that tumor budding is a practical, cost-effective marker of disease aggressiveness. Its presence on standard histology could help guide treatment planning, particularly in decisions regarding elective neck dissection. Further validation in prospective, multi-institution studies is needed to confirm its clinical utility.
The authors reported no conflicts of interest.
Source: Journal of Clinical Medicine