Tumor Budding Density Associated with Survivin Expression in Colorectal Carcinoma

Abstract: Background: Colorectal carcinoma (CRC) is the third most common malignancy. Tumor Budding was a single or small (up to 5 cells) undifferentiated cells at the edge of tumor invasion. Cells in tumor budding show low mitotic index and apoptosis. Survivin is an apoptotic inhibitor protein. This study aims to prove the association between tumor budding density and survivin expression. Method: This study was an analytical cross-sectional study conducted on 43 cases of CRC. Evaluation of tumor budding density was calculated on the H-E staining using the 10 field of view, then categorized as high density when found> 100 tumor budding/10 high power field and low density when found ? 100 tumor budding/10 high power field. Survivin expression was assessed by immunohistochemistry (IHC) and was categorized as high if it contained> 25% of tumor cells and was low if ?25% of tumor cells. The results of the study were analyzed by x2 test to determine differences in survivin expression in high and low density tumor budding, and the mean difference survivin expression in both groups of tumor budding with the Spearman rho test. The degree of significance is determined at p <0.05. Results: From 43 samples, 21 cases of high density tumor budding and 22 cases of low density tumor budding were obtained. High density tumor budding with high survivin expression were found in 18 cases (85.7%) while high density tumor budding with low survivin expression was found in 3 cases (14.3%). Low density tumor budding with high survivin expression of 6 cases (27.3%). Low density tumor budding with low survivin expression 16 cases (72.7%). There was a significant difference in survivin expression in the high and low density tumor budding group (p = 0.001), with an odd ratio of 16.00 (95% confidence interval 3.42-74.69). The Spearmans rho test showed that the mean percentage of Survivin expression in the high density CRC case group differed significantly from the mean survivin percentage in the low density CRC case group (p <0.001). Conclusion: Budding tumor density is related to survivin expression. CRC with high density tumor budding has 16 times higher risk showing high survivin expression compared to CRC with low density tumor budding.