The prognostic role of tumor budding and tumor-stroma ratio in pulmonary metastasis of colorectal carcinoma

Topias Karjula, Niko Kemi, Anne Niskakangas, Olli Mustonen, Iiris Puro, Vesa Matti Pohjanen, Teijo Kuopio, Hanna Elomaa, Maarit Ahtiainen, Jukka Pekka Mecklin, Toni T. Seppälä, Erkki Ville Wirta, Eero Sihvo, Juha P. Väyrynen, Fredrik Yannopoulos, Olli Helminen

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Objective: To evaluate the prognostic value of tumor budding and tumor-stroma ratio (TSR) in resected pulmonary metastases of colorectal carcinoma (CRC). Methods: In total, 106 pulmonary metastasectomies were performed to 74 patients in two study hospitals during 2000–2020. All relevant clinical data were retrospectively collected. Tumor budding based on the International Tumor Budding Consensus Conference recommendations and TSR in the first resected pulmonary metastases and primary tumors were evaluated from diagnostic hematoxylin-eosin-stained histopathological slides. Results: 60 patients (85.7%) had low tumor budding (≤5 buds/field) and 10 patients (14.3%) had high tumor budding (>5 buds/field) in their first pulmonary metastases of CRC. 5-year overall survival rates of pulmonary metastasectomy in low and high total tumor budding were 28.3% and 37.3% (p = 0.387), respectively. 19 patients (27.1%) had low TSR and 51 patients (72.9%) had high TSR. The 5-year overall survival rates were 32.9% in low and 28.6% in high TSR of first pulmonary metastases (p = 0.746). Tumor budding and TSR did not provide prognostic value in Cox multivariate analysis. Tumor budding and TSR in resected pulmonary metastases were not associated with those of the primary tumor. Conclusion: Tumor budding and TSR in the resected pulmonary metastases of CRC showed no statistically significant prognostic value, however, additional well-powered confirmatory studies are needed.

Original languageEnglish
Pages (from-to)1298-1306
Number of pages9
JournalEuropean Journal of Surgical Oncology
Issue number7
Publication statusPublished - 2023
Publication typeA1 Journal article-refereed


  • Colorectal cancer
  • Pulmonary metastases
  • Tumor budding
  • Tumor-stroma ratio

Publication forum classification

  • Publication forum level 1

ASJC Scopus subject areas

  • Surgery
  • Oncology


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