PROGNOSTIC VALUE OF TUMOR BUDDING IN SPORADIC COLORECTAL CANCER STAGE II PATIENTS WITH A LOW NUMBER OF LYMPH NODES EXAMINED.

Stage II colorectal cancer (CRC) is a major therapeutic challenge because it is not easy to decide whether patients will benefit from adjuvant chemotherapy or not. This study was designed as a retrospective prognostic study combining standard histopathologic parameters with tumor budding and microsatellite instability. The study included 89 patients on elective treatment for stage II primary colorectal adenocarcinoma from January 2011 to December 2015. Study results indicated that the prognosis of patients with stage II CRC depended on the combination of three factors, (in the order of importance): number of lymph nodes examined; total number of buds per 0.785 mm2 (≥5.5); and positive lymphovascular invasion. There is increasing evidence that tumor biology and non-anatomic characteristics are important in the prognosis and treatment of CRC. One of them is tumor budding which is not yet an integral part of the AJCC staging system. A low number of the lymph nodes examined is associated with high-risk patients. All patients without an adequate number of lymph nodes examined (less than 8 lymph nodes) should a priori be considered a very high-risk group, with a very low survival rate, and chemotherapy should be used.