The role of tumor budding in early-stage laryngeal cancer treatment selection

Abstract

Objective: Laryngeal cancer is a prevalent malignant neoplasm, with early-stage glottic tumors treated with surgery or radiotherapy. Radioresistance significantly complicates treatment, highlighting the necessity for early detection methods. This study aimed to evaluate the relationship between tumor budding and radiotherapy outcomes in affected patients. Methods: This investigation encompassed patients diagnosed with early-stage squamous cell carcinoma of the glottic larynx who received radiotherapy and had a minimum follow-up of 1 year. Pathological specimens collected at diagnosis were reassessed for tumor budding. The data were analyzed to determine the best cut-off value for tumor budding to predict radioresistance and differences in survival based on tumor budding cut-off value. Results: The study cohort comprised 49 patients who met the pre-established criteria. The radioresistant group comprised 14 patients. All except one patient were male (mean age: 64 years). The best cut-off value for tumor budding was determined as 2. Patients categorized into high risk (tumor budding ≥ 2) had a significantly higher chance of radiotherapy failure than those with low risk (tumor budding < 2, AUC = 0.696; p = 0.034; sensitivity = 78.6%; specificity = 62.9%). The high risk group also had a significantly reduced 5-year disease-free survival compared to the low risk group (p = 0.008). Overall survival was similar. Conclusion: The prognosis for early-stage glottic laryngeal cancer is generally favorable, yet a standardized risk stratification tool for treatment selection remains lacking. Tumor budding assessment in routine histopathology could help identify patients at higher risk of recurrence, guiding decisions on radiotherapy intensity and post-treatment surveillance. Integrating tumor budding into clinical practice may support more personalized treatment strategies, ultimately improving patient outcomes. Level of Evidence: 3.