Tumor Budding Significance as a Biomarker for Clinicopathology and Prognostic Evaluation in Gynecological Malignancy: A Bayesian Meta-Analysis

Wiguna, I Gede Wikania Wira; Armerinayanti, Ni Wayan; Mamangdean, Christo Timothy; Mahayana, Ngakan Putu Krishna; Putri, Putu Mirah Wahyu Subagia; Tungga, Kadek Meryndha Kumala; Simanjuntak, Artha Maressa Theodora; Wijayanto, Frengki Prabowo Saputro; Khanaruksombat, Suparada; Winata, I Gde Sastra

doi:10.31557/APJCP.2026.27.4.1323

Tumor Budding Significance as a Biomarker for Clinicopathology and Prognostic Evaluation in Gynecological Malignancy: A Bayesian Meta-Analysis

Document Type : Research Articles

Authors

¹ Department of Anatomical Pathology, Faculty of Medicine and Health Science, Warmadewa University, Denpasar, 80235, Indonesia.

² Faculty of Medicine, Udayana University, Denpasar, 80232, Indonesia.

³ Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Sleman 55281, Indonesia.

⁴ Siriraj Center of Research Excellence for Cancer Immunotherapy, Research Department, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.

⁵ Departement of Obstetrics and Gynecology, Faculty of Medicine, Udayana University, Prof. Dr. I G.N.G. Ngoerah General Hospital, Denpasar, 80232, Indonesia.

10.31557/APJCP.2026.27.4.1323

Abstract

Objective: Tumor budding (TB) has been recommended as a marker for prognosis and therapeutic decision-making in various types of cancer, yet it has not been comprehensively studied in gynecological malignancies. This study aimed to evaluate the relationship between TB and clinicopathological features, as well as prognosis, in patients with gynecological malignancies, using a Bayesian meta-analysis design. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 protocol was followed. A systematic literature search was conducted using PubMed, ScienceDirect, and Cochrane databases. A meta-analysis was performed to assess the relationship between TB and clinicopathological parameters using odds ratios (ORs). Prognostic outcomes were analyzed using hazard ratios (HRs). Specific Bayesian priors were applied to each variable. Data analysis was conducted using R (version 4.4.0). Results: Eighteen cohort studies (n = 3,320) involving patients with cervical and endometrial cancer were included. Bayesian meta-analysis showed that TB was significantly associated with clinicopathological parameters, specifically cancer stage (OR=2.91; 95%CrI: 1.86–4.41; prediction interval (PI) OR=2.92; 95%CrI: 0.82–9.92; τ2=0.53), grading (OR=5.00; 95%CrI: 2.83–8.76; PI OR=5.00; 95% CrI: 0.89–27.87; τ2=0.77), nodal involvement (OR=3.63; 95%CrI: 2.41–5.47; PI OR=3.63; 95%CrI: 0.85–15.52; τ2=0.66), and lymphovascular invasion (LVI) (OR=4.22; 95%CrI: 2.52–6.92; PI OR=4.22; 95%CrI: 0.63–27.80; τ2=0.89). Overall survival (OS) showed an HR of 2.14 (95%CrI: 1.27–3.63; PI HR=2.14; 95%CrI: 0.83–5.58; τ2=0.25) and DFS showed an HR of 1.20 (95%CrI: 0.77–1.59; PI HR=1.21; 95%CrI: 0.14–2.20; τ2=0.42). Conclusion: Tumor budding is significantly associated with clinicopathological features and prognosis in patients with gynecological malignancies.

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