Fecha de publicación: -- Fuente: PubMed "nature biotechnology" Hum Pathol. 2026 Nov 7:106303. doi: 10.1016/j.humpath.2026.106303. Online ahead of print.ABSTRACTTumor budding and poorly differentiated clusters (PDCs) have been reported to have prognostic value in various malignancies. However, their relevance in primary duodenal adenocarcinoma remains unclear. This study evaluated the prognostic significance and interobserver agreement of tumor budding and PDCs in patients with pT1b or more advanced primary duodenal adenocarcinoma who underwent endoscopic or surgical resection between 2005 and 2023. Tumor budding and PDCs were assessed by three observers on hematoxylin and eosin-stained sections, classified as low (<5) or high (≥5), and designated as BD-low or BD-high and PDC-low or PDC-high, respectively. Among the 46 patients analyzed, the interobserver agreement was substantial for tumor budding (κ=0.65, 95% confidence interval [CI] 0.47-0.82) and moderate for PDCs (κ=0.48, 95% CI 0.27-0.65). BD-high and PDC-high were associated with adverse pathological features, including larger tumor size, advanced pathological T and N stages, and lymphatic permeation. BD-high was associated with lower recurrence-free survival (RFS; P=0.013) and overall survival (OS; P=0.004), whereas PDC-high was associated with lower RFS (P=0.022) and OS (P=0.045). Tumor budding and PDCs were associated with adverse pathological features and poorer survival outcomes, with acceptable interobserver reproducibility. Our findings support the clinical applicability of tumor budding and PDC assessment for pathological risk stratification in primary duodenal adenocarcinoma.PMID:42998686 | DOI:10.1016/j.humpath.2026.106303