Tissue Budding Expression Associated with Histopathological Characteristics in Patients Undergoing Neoadjuvant Therapy for pT3N0M0/pT3N1M0 Adenocarcinoma of the Rectum Extraperitoneum

Valdemir Jose Alegre Salles, Sarhan Sydney Saad, Julia Nicioli, Juliana Almeida Lopes, Milena dos Santos Rodrigues da Silva, Isabela Simoes de Araujo Alegre Salles

Tissue Budding, Colorectal Cancer, Desmoplasia, Angio-lymphatic Invasion, Peri-tumoral Inflammatory Infiltrate, Metastasis, Neoplastic Disease-free Survival.

Introduction: Malignant colorectal cancer is the third most common cancer in men and the second most common in women from the 5th decade onwards. The TNM system is often used in pre and post-operative staging, and the use of other hematimetric parameters for the prognosis of colorectal cancer are sometimes decisive in more accurate assessments. Tumor budding has been defined as the presence of isolated neoplastic cells or small groups of cells present in the stroma at the margin of the tumor, with studies showing its relationship with the prognosis of malignant disease, especially those related to poor survival and a high risk of recurrence. Objective: To investigate the prognostic value of tumor tissue budding expression in patients with extra-peritoneal rectal cancer pT3N0M0/pT3N1M0, undergoing radical curative surgery after neoadjuvant chemoradiotherapy, considering its influence on histopathological parameters and malignant disease-free survival time. Methodology: 46 results of the histopathological examination of patients undergoing neo-adjuvant therapy for the treatment of rectal-extraperitoneal adenocarcinoma were analyzed, taking into account the values of tissue budding, desmoplasia, angio-lymphatic invasion, peri-tumoral inflammatory infiltrate, presence of lymph node metastasis, tumor extension and neoplastic disease-free survival time. The study group consisted of 23 men and 23 women, regardless of race, with a mean overall age of 66.5 years. Results: Using Student's t-test, a statistical significance was defined for the relationship of positive budding with angio-lymphatic invasion (p=0.019), with ganglion resection count (p=0.001), tumor extension (p=0.028) and in neoplastic disease-free survival time (p=0.058). When associated according to gender, a statistically significant relationship was observed in male patients between angio-lymphatic invasion (p=0.006) and the presence of lymph node metastasis (p=0.009), while in females the relationship was present in terms of the number of resected lymph nodes (p=0.006) and with a greater trend in disease-free survival time (p=0.065). The Chi-Square test was applied to analyze the variables, desmoplasia (p=0,749), angio-lymphatic invasion (p=0,020) and peri-tumor inflammatory infiltrate (p=0,079). There was statistical significance in the relationship between angio-lymphatic invasion and the presence of lymph node metastasis (p=0.041). Considering p<0.05 as statistically significant. Conclusion: This study found that patients with extra-peritoneal pT3N0M0/pT3N1M0 adenocarcinoma of the rectum undergoing neo-adjuvant therapy associated with abdominal rectosigmoidectomy confirmed that the presence of tissue budding influences angio-lymphatic invasion, ganglion resection count, maximum lesion extension and malignant disease-free survival time, and the presence of metastatic ganglion involvement in males.

https://doi.org/10.31871/WJRR.19.2.3