Sinonasal intestinal-type adenocarcinoma (ITAC) is a very rare, closely occupational-related tumor with strong histological similarities to colorectal cancer (CRC). In the latter, tumor budding (TB) is widely recognized as a negative prognostic parameter. The aim of this study was to evaluate the prognostic role of TB in ITAC and to correlate it with other established or emerging biomarkers of the disease, such as p53 and deficient DNA mismatch repair (MMR) system status/microsatellite instability (MSI). We retrospectively analyzed 32 consecutive specimens of patients with ITAC diagnosis treated in two institutions in Northern Italy. We reviewed surgical specimens for TB evaluation (low-intermediate/high); p53 expression and MMR proteins were evaluated via immunohistochemistry. Results were retrospectively stratified using clinical data and patients’ outcomes. According to bud counts, patients were stratified into two groups: intermediate/high budding (>4 TB) and low budding (≤4 TB). Patients with high TB (>4) have an increased risk of recurrence and death compared to those with low TB, with a median survival of 13 and 54 months, respectively. On multivariate analysis, considering TB, therapy, and stage as covariates, TB emerged as an independent prognostic factor net of the stage of disease or type of therapy received. No impact of p53 status as a biomarker of prognosis was observed and no alterations regarding MMR proteins were identified. The results of the present work provide further significant evidence on the prognostic role of TB in ITAC and underline the need for larger multicenter studies to implement the use of TB in clinical practice.
鼻腔鼻窦肠型腺癌是一种极为罕见且与职业暴露密切相关的肿瘤，其组织学特征与结直肠癌高度相似。在结直肠癌中，肿瘤出芽已被广泛认定为不良预后指标。本研究旨在评估肿瘤出芽在鼻腔鼻窦肠型腺癌中的预后价值，并将其与该疾病其他已确立或新兴的生物标志物（如p53及错配修复系统缺陷状态/微卫星不稳定性）进行关联分析。我们回顾性分析了意大利北部两家医疗机构连续收治的32例鼻腔鼻窦肠型腺癌患者的病理标本。通过复查手术标本进行肿瘤出芽分级评估（低-中/高级别），并采用免疫组织化学法检测p53表达及错配修复蛋白状态。结合临床数据和患者结局对检测结果进行回顾性分层分析。 根据出芽计数，患者被分为两组：中/高出芽组（>4个肿瘤出芽）和低出芽组（≤4个肿瘤出芽）。与低出芽组相比，高出芽组（>4个）患者的复发和死亡风险显著增加，中位生存期分别为13个月和54个月。在多变量分析中，将肿瘤出芽、治疗方案及分期作为协变量纳入考量，结果显示肿瘤出芽是独立于疾病分期或所接受治疗类型的预后因素。未观察到p53状态作为预后生物标志物的影响，也未发现错配修复蛋白相关异常。 本研究结果为肿瘤出芽在鼻腔鼻窦肠型腺癌中的预后作用提供了重要证据，并强调需要通过更大规模的多中心研究来推动肿瘤出芽评估在临床实践中的应用。
肿瘤(癌症)患者之家