Tumor budding as a predictive factor of lymph node metastases and survival in endometrial cancer patients: A systematic review and meta-analysis.
Maria Fanaki, Vasilios Lygizos, Thomakos Nikolaos et al.
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In 30 seconds
This systematic review and meta-analysis examined whether tumor budding (isolated cells or small clusters at the invasive front) is associated with survival and lymph node positivity in endometrial cancer. Ten observational studies involving 1307 patients were included. Tumor budding was associated with worse progression-free survival (HR 2.44, 95% CI 1.53-3.89) and overall survival (HR 1.89, 95% CI 1.21-2.96). These survival associations weakened after accounting for small-study effects, while the evidence linking tumor budding to lymph node metastasis was inconsistent and not robust to potential bias.
Key findings
- Tumor budding was associated with reduced progression-free survival (HR 2.44, 95% CI 1.53-3.89).
- Tumor budding was associated with reduced overall survival (HR 1.89, 95% CI 1.21-2.96).
- Associations with survival attenuated after accounting for small-study effects, although trim-and-fill estimates remained significant for progression-free survival.
- Evidence linking tumor budding with lymph node metastasis was inconsistent and not robust after correction for potential bias.
Why it matters
The findings suggest tumor budding may help identify endometrial cancers associated with poorer survival, making it a potentially useful histopathological prognostic marker. However, variation in how budding is assessed and limited integration with molecular classification mean its prognostic contribution is not yet established well enough to guide treatment decisions.
What to keep in mind
The evidence comes from observational studies, and the authors note heterogeneity in assessment methods and limited integration with molecular classification. Survival associations weakened after accounting for small-study effects.