Tumor budding index and microvessel density assessment in patients with endometrial cancer: A pilot study

Tomasz Kluz; Tomasz Łoziński; Sylwia Czekierdowska; Norbert Stachowicz; Grzegorz Gurynowicz; Mieczysław Chróściel; Artur Czekierdowski

doi:10.3892/ol.2020.11811

Tumor budding index and microvessel density assessment in patients with endometrial cancer: A pilot study

Oncol Lett. 2020 Sep;20(3):2701-2710. doi: 10.3892/ol.2020.11811. Epub 2020 Jul 3.

Authors

Tomasz Kluz¹, Tomasz Łoziński², Sylwia Czekierdowska³, Norbert Stachowicz³, Grzegorz Gurynowicz⁴, Mieczysław Chróściel⁵, Artur Czekierdowski³

Affiliations

¹ Department of Obstetrics and Gynecology, Fryderyk Chopin University Hospital No. 1, Faculty of Medicine, Rzeszow University, 35-055 Rzeszow, Poland.
² Department of Obstetrics and Gynecology, Pro-Familia Hospital, 35-302 Rzeszow, Poland.
³ Department of Gynecological Oncology and Gynecology, Poznan University of Medical Sciences, 60-535 Poznan, Poland.
⁴ Division of Perinatology and Women's Diseases, Poznan University of Medical Sciences, 60-535 Poznan, Poland.
⁵ Chair and Department of Epidemiology and Clinical Research Methodology, Medical University of Lublin, 20-081 Lublin, Poland.

Abstract

The present study aimed to analyze the association between tumor budding index (TBI) and microvessel density (MVD) and selected clinicopathological features in female patients with endometrial cancer (EC). The present study included 137 patients, of whom 117 had endometrial endometrioid cancer and 3 had non-endometrioid EC (NEEC). Additionally, 8 cases of simple endometrial hyperplasia and 9 cases of atypical endometrial hyperplasia were included in the present study. Patient age, menopausal status, tumor histological type, grade and International Federation of Gynecologists and Obstetricians (FIGO) clinical stage were investigated. Immunohistochemistry was utilized to detect MVD using a CD34 antibody, and a laminin-5γ2 antibody was used for TBI assessment. In nonmalignant endometrial lesions, the TBI was significantly lower than that in patients with EC and NEEC (P=0.002). Significant differences in median TBI (MD-TBI) were also observed between patients with low-grade EC (MD-TBI, 4.5) and high-grade EC (MD-TBI, 16.2; P=0.01). Age, body mass index and tumor FIGO stage were not indicated to be associated with the MD-TBI. Premenopausal patients with EC had lower MD-TBI values than postmenopausal patients (0.3 vs. 11.1; P<0.005). The median MVD-CD34 in the study group was 19 (range, 13-29). Significant differences in MVD-CD34 were observed between malignant and nonmalignant endometrial lesions (P=0.01). Histological grade was markedly associated with tumor MVD-CD34 (P=0.001). The MVD was higher in high-grade cancer (G3; MVD-CD34, 24.9) than in grade G1 and G2 lesions (MVD-CD34, 14 and 18.6, respectively; P=0.01). FIGO clinical stage was not associated with MVD-CD34 in low and high stage lesions (MD, 18.4 for FIGO stage I/II; MD, 17.6 for FIGO stage III/IV; P=0.2). High MVD was markedly associated with high MD-TBI (P=0.0002). In conclusion, TBI could be a valuable indicator of tumor aggressiveness in patients with EC. The presence of the tumor budding phenomenon with increased MVD may have the potential to further refine clinical management decisions when endometrial malignancy is detected.

Keywords: endometrial cancer; laminin-5γ2; microvessel density; tumor budding index.