Tumor cell budding in preoperative biopsies of esophageal and gastroesophageal junction carcinoma independently predicts survival in a grade-dependent manner

Tumor budding is a prognostic factor in biopsies of different tumor entities. Recent evidence suggests that this also applies to esophageal squamous cell carcinomas. Since esophageal cancer is diagnosed by biopsy, the aim of this study was to investigate whether tumor budding in pretherapeutic biopsies of a mixed tumor population of the esophagus and gastroesophageal junction might predict survival. In this retrospective analysis, samples of 78 patients were analyzed (55 adenocarcinomas, 17 squamous cell carcinomas, 5 adenosquamous carcinomas, 1 carcinosarcoma). In addition to preoperative biopsies, budding foci in corresponding resection specimens were assessed and related to overall and relapse-free survival. The main finding was that the number of budding foci in preoperative biopsies predicted overall survival independent of the patient's age and disease stage in a grade-specific (P = .009) manner. In patients with grade 2 tumors, each additional budding focus was associated with an increased chance of death by a factor of 1.28 (hazard ratio 95% confidence interval 1.06-1.55, P = .011). There was no significant association between survival and the number of budding foci in patients with grade 3 tumors, and no budding was observed in grade 1 tumors. Budding foci in resection specimens also showed a certain association with survival, but to a lesser degree. Budding foci in preoperative biopsies might serve to improve prognostic accuracy in esophageal carcinomas.