Prognostic value of local invasion patterns in upper gastrointestinal cancers
Jakab Ákos
Pathological and Oncological Divison
Dr. Matolcsy András
SE I.sz. Patológiai és Kísérleti Rákkutató Intézet tanterme
2026-06-11 14:30:00
Diagnostic, Digital and Molecular Pathology
Dr. Kiss András
Dr. Lotz Gábor és Dr. Kocsmár Éva
Dr. Krencz Ildikó
Dr. Forika Gertrúd
Dr. Szabó Dóra
Dr. Mohos Anita
Dr. Schlachter Krisztina
Local invasion patterns are useful biomarkers determinable from conventional histologic slides. Tumor budding and poorly differentiated clusters (PDCs) are histologic manifestations of the epithelial-mesenchymal transition. They have been incorporated into the routine diagnostics of colorectal cancers in 2016, when the International Tumor Budding Consensus Conference (ITBCC) has established the standard methods of their evaluation. Stroma AReactive Invasion Front Area (SARIFA) is a newly discovered phenomenon, where tumor cells make direct contact with adipocytes. We have assessed tumor buds (TBs) and PDCs in a cohort of gastric adenocarcinoma patients, and in a separate cohort of esophageal cancer patients with the addition of SARIFA. Both cohorts comprised of distinct histological subtypes. The gastric cancer (GC) cohort contained intestinal and diffuse adenocarcinomas, while the esophageal cancer cohort was constituted of squamous cell cancers (ESQCCs) and adenocarcinomas (EACs). We collected and digitized the histologic slides of the patients along with obtaining their clinical and pathological data, yielding 290 cases in the gastric cohort and 100 cases in the esophageal cohort available for analysis. Our results proved that TBs, PDCs and SARIFA have strong correlations with other established clinicopathological biomarkers, as well as with each other. Each have distinct advantages, tumor budding is an independent prognostic factor of lymph node metastases (LNMs) in ESQCCs, while SARIFA predicts the same consequence in EACs. We have found that SARIFA occurs more frequently in EACs containing greater numbers of small cell clusters (TBs and PDCs of less than 15 cells), while also being characteristic of higher T stage (3 and 4) EACs. Moreover, we also assessed SARIFA in ESQCCs, which to our knowledge is the first occasion of evaluating the aforementioned marker in squamous cell cancers. In gastric cancers, although TBs outperformed PDCs in predicting the development of LNMs, both TBs and PDCs correlate with the lymph node ratio. Our results revealed that TB and PDC scores are not predictive of the overall survival of esophageal cancer patients, however, the absolute number of cell clusters in the TB and PDC categories are an independent prognostic factor for the aforementioned endpoint, shedding light on the need to revise the cut-off value before implementing TBs and PDCs in the routine diagnostics of esophageal cancers.
