Tumor budding in non-small cell lung cancer: a new prognostic frontier?

Despite advancements in treatment methods, prognosis can vary among patients with the same stage of Non-Small Cell Lung Cancer (NSCLC). Tumor budding (Tb) in the tumor microenvironment is increasingly studied to improve prognostic accuracy. This study aims to compare the prognostic value of Tb with established factors in NSCLC patients who underwent surgery. This retrospective study included NSCLC patients operated on between January 2018 and December 2023. Data collected included clinical and pathological characteristics, tumor type, stage, spread through air spaces (STAS), lymphovascular invasion (LVI), perineural invasion (PNI), and survival times. Tb was assessed in peritumoral (pBd1-2-3) and intratumoral (iBd1-2-3) areas using the International Tumor Budding Consensus Conference criteria. The relationship between pBd and iBd with prognostic factors, overall survival (OS), and disease-free survival (DFS) was analyzed. Patients with pBd2 and pBd3 had a significantly higher presence of STAS, LVI, and PNI than those with pBd1 (p = 0.025, p = 0.027, p = 0.003). No significant differences were found between iBd groups (p = 0.799). There was no significant difference in DFS among pBd groups (p = 0.925). No significant difference in OS was observed between pBd and iBd groups (p = 0.799 and p = 0.943). In the multivariate analysis, although many factors did not reach independent significance likely due to the limited cohort size, iBd2 emerged as a potential independent prognostic indicator for both DFS (p = 0.004) and OS (p = 0.006). These findings, while exploratory due to the small sample size, suggest that iBd may provide additional prognostic value beyond conventional parameters. Tb's association with known prognostic factors suggests it may aid in lung cancer prognosis. Standardized assessment and routine pathological evaluation could impact treatment decisions.