High-grade tumor budding influences prognosis of I-II stage cervical cancer: a systematic review and meta-analysis

Objective: The aim of this study is to investigate the prognostic correlation between tumor budding and stage I-II cervical cancer, with the goal of providing guidance for postoperative diagnosis and treatment strategies for patients. Methods: A comprehensive search was conducted across 12 databases including Pubmed, Cochrane, Embase, Scopus, OVID, Web of Science, EBSCohost, CNKI, Wan-Fang, VIP, Dui-Xiu and CBM to identify relevant literature on the association between tumor budding and prognosis or clinicopathological features of cervical cancer.The quality of included studies was assessed using the Newcastle-Ottawa scale. Statistical analysis was performed using Review Manager. Results: Our findings demonstrate that high-grade tumor budding in stage I-II cervical cancer is associated with significantly poorer overall survival (P<0.0001) and disease-free survival (P<0.0001). Subgroup analyses revealed that irrespective of sample size and histological type, the overall survival in the high-grade tumor budding group is markedly lower than that in the low-grade tumor budding group; similarly regardless of stage inclusion criteria, budding type, field boundary value or sample size,the disease-free survival in the high-grade tumor budding group is significantly lower than that in the low-grade tumor budding group.Furthermore,high grade tumor budding is correlated with several adverse pathological features. Conclusion: In light of these results,it can be concluded that tumor budding serves as an unfavorable prognostic factor for stage I-II cervical cancer,and may inform I-II stage postoperative treatment planning for such patients.