Current clinical practice guidelines in oncology issued by the National Comprehensive Cancer Network (NCCN; version 2.2017) include incorporation of tumor budding in clinical treatment, advising that "tumor budding has been shown to be an adverse histological feature associated with adverse outcome and may preclude polypectomy as an adequate treatment of endoscopically removed malignant polyps." (24) Similar guidelines are currently used in the management of patients with colorectal carcinoma in Japan (JSCCR
) and Europe (European Society for Medical Oncology).
The Japanese Society for Cancer of the Colon and Rectum (JSCCR
) classifies PM into three subgroups: P1 indicates metastases only to adjacent peritoneum, P2 stands for a few metastases to distant peritoneum, and P3 represents numerous metastases to distant peritoneum.
Shimadaet al., "Japanese Society for Cancer of the Colon and Rectum (JSCCR
) guidelines 2010 for the treatment of colorectal cancer," International Journal of Clinical Oncology, vol.
In view of morphology, the protruding tumor included the sessile and subpedunculated types, and the superficial tumor included the elevated, flat, and depressed types, in accordance with the Japanese Classification of Colorectal Carcinoma (JSCCR