Predicting lymph node metastasis in gastric adenocarcinoma: Role of tumor budding and immunohistochemical expression of E-cadherin

Introduction: Predicting the node status of stomach carcinoma is very useful, as it affects treatment decisions. The objective of this study was to use the immunohistochemical expression of E-cadherin and tumor budding to investigate the nodal status of gastric cancer surgical specimens as a pilot study before application to gastric cancer biopsy samples. Methods: Three hundred and eleven (311) gastric cancer surgical samples with lymph node dissection were retrospectively evaluated at Hanoi Medical University Hospital, Vietnam. The comparison of tumor budding and E-cadherin expression with lymph node status was investigated. Tumor budding was calculated on the microfield of 0.785 mm(2 )according to the 2016 International Consensus Conference guidelines. The immunoexpression of the E-Cadherin protein was examined by immunohistochemistry. Results: The overall lymph node metastasis rate was 55.6%. In multivariable logistic regression analyses, tumor budding (odds ratio [OR] = 12.73, 95% confidence interval [CI] = 4.980-32.53, p < 0.001), immunoexpression of E-cadherin (OR =0.048, 95% CI = 0.019-0.121, p < 0.001), stage (OR = 2.329, 95% CI =1.204-4.504, p = 0.012), and grade (OR = 2.032, 95% CI = 1.081-3.820, p = 0.028) were critical factors that can independently predict lymph node status. Conclusions: Tumor budding and E-cadherin expression are independent factors and may be additional candidates in predicting node status in patients with primary gastric carcinoma.