Association of tumor budding with prognostic factors and lymph node metastasis in penile cancer: A prospective cohort of 218 cases.

Histopathological evaluation of lymph nodes in penile cancer remains the gold standard for identifying lymph node metastases; however, it is an invasive procedure that can lead to postoperative complications. Several studies have reported that tumor budding is an independent prognostic factor for locoregional disease recurrence in many solid cancers. We evaluated the relationship between tumor budding categories and other histological parameters of aggressiveness in 218 patients diagnosed with penile squamous cell carcinoma. We performed a prospective cohort study with a 6-month follow-up period. Clinical data were extracted from the medical records and patient interviews, and pathologists evaluated histopathological data. Tumor budding was associated with histopathological characteristics and the appearance of nodal metastasis within 6 months of diagnosis. The chi-square test was applied at a significance level of 5 %. Our study demonstrated a statistically significant association between tumor budding scores of 2 and 3 and the following variables: high histological grade (G2 and G3), presence of angiolymphatic invasion, presence of perineural invasion, higher pathological stage (pT3 and pT4), and presence of nodal metastasis. This may indicate that moderate/high-grade tumor growth (scores of 2 and 3) is related to a more aggressive behavior of penile squamous cell carcinoma. Tumor budding shows promise as a prognostic tool in histopathological evaluations, particularly for predicting lymph node metastases. Its simplicity makes it an accessible method, especially in underdeveloped countries and regions with high incidence rates of this neoplasm.