肿瘤萌芽现象(TB)和最小肿块巢大小(MCNS)在人类乳头瘤病毒(HPV)阴性的头颈部鳞癌(HNSCC)中具有预后意义。然而，阈值的优化、在HPV阳性HNSCC中的预后影响以及与其他组织病理分级系统的比较尚未得到充分探讨。TB和MCNS在TCGA的331个HPV阳性和阴性病例中数字化分析了1和10个高倍视野(HPF)。优化阈值定义了一个新的细胞分离分级(CDG)系统，并与WHO分级和Brandwein-Gensler(BG)危险模型进行了比较。仅基于TB的两级CDG系统在CDG高病例中实现了最佳预后分层，并缩短了总生存期。最佳阈值分别为两个芽(1 HPF)和六个芽(10 HPF)。分析MCNS对量化TB没有增加预后意义。CDG是HPV阴性和阴性肿瘤的重要预后标志物，并且在预后上优于WHO和BG系统。高CDG与临床隐匿淋巴结转移相关。迄今为止，在HNSCC中最全面的TB研究确认了其在HPV阴性肿瘤中的预后影响，并首次在HPV阳性肿瘤中确定了其预后影响。需要进一步研究以评估其在HNSCC治疗指导中的适用性。©2023.作者(们)。

The prognostic significance of tumour budding (TB) and minimal cell nest size (MCNS) was shown in human papillomavirus (HPV)-negative head and neck squamous cell carcinomas (HNSCC). However, the optimisation of cutpoints, the prognostic impact in HPV-positive HNSCC, and the comparison with other histopathological grading systems are insufficiently investigated.TB and MCNS were analysed digitally in 1 and 10 high-power fields (HPF) of 331 HPV-positive and HPV-negative cases from TCGA. Optimising the cutpoints a new cellular dissociation grading (CDG) system was defined and compared to the WHO grading and the Brandwein-Gensler (BG) risk model.The two-tiered CDG system based solely on TB yielded optimal prognostic stratification with shortened overall survival for CDG-high cases. Optimal cut-offs were two buds (1 HPF) and six buds (10 HPF), respectively. Analysing MCNS did not add prognostic significance to quantifying TB. CDG was a significant prognostic marker in HPV-negative and HPV-positive tumours and prognostically superior to the WHO and BG systems. High CDG was associated with clinically occult lymph-node metastases.The most comprehensive study of TB in HNSCC so far confirmed its prognostic impact in HPV-negative tumours and for the first time in HPV-positive tumours. Further studies are warranted to evaluate its applicability for therapy guidance in HNSCC.© 2023. The Author(s).