Association Between Tumor Budding Grade and T Stage in Predicting Recurrence in High-risk Stage Ii Colorectal Cancer

Abstract In pathological stage (pStage) II colon cancer, factors such as T stage (T) are high-risk features (HRF) for recurrence. The SACURA trial showed that tumor budding (BD) grade was also associated with recurrence: the 5-year recurrence-free survival (RFS) rate was lower in patients in the BD3 group compared with that of other groups. Interestingly, the BD3 group had a higher proportion of patients with T4. We investigated the prognostic association between T4 and BD3 for recurrence in pStage II colorectal cancer (pII-CRC) with HRF. We analyzed pII-CRC patients with HRF between 2013–2018 at our hospital, Japan. Inclusion criteria were as follows: ≥1 HRF [<12 lymph nodes examined (<12LN), lymph/vascular-invasion, perineural-invasion, T, BD, and histologic-type]. We primarily analyzed the relationship between each factor and RFS. Among 2,920 pII-CRC patients, 448 had HRF. Of these, 43 (9.6%) had T4 and 236 (52.7%) had BD3. On initial analysis, <12LN (P=0.0412), tumor location (P=0.0023), T4 (P=0.0023), and BD3 (P=0.0396) were independent prognostic factors for RFS. Among 257 patients with BD3 and/or T4, the 5-year RFS rates were 81.3%, 74.6%, and 66.2% for patients with BD3 (214 patients), T4 (22 patients), and BD3 plus T4 (21 patients), respectively (hazard ratio 3.08, P=0.0079). pII-CRC patients with BD3 plus T4 had poorer prognosis than those with other factors.