Ulase D, et al. - In a large and a well-characterized European gastric cancer (GC) cohort, researchers performed an independent evaluation of the utility and prognostic value of tumor budding (TB) according to the International tumor Budding Consensus Conference (ITBCC) criteria. In 456 consecutive, surgically treated GCs, they evaluated TB based on the ITBCC criteria and scored GCs as Bd0 (no buds), Bd1 (1–4 buds), Bd2 (5–9 buds) or Bd3 (≥ 10 buds). Division of cases with TB present into low-budding (Bd1/Bd2) and high-budding (Bd3) groups was done. Observations revealed the significant correlation of the TB score with sex; Laurén phenotype; pT-, pN- and M categories; histological grade; R status; lymph node ratio; lymphatic invasion; perineural invasion; and HER2-, MET- and MSI status. They identified significant associations between the presence and extent of TB and the presence of lymph node metastasis in both total and intestinal-type early invasive GC (n = 57 and n = 41, respectively). The TB groups showed significant differences in overall survival and tumor-specific survival; however, in multivariate models, TB did not retain significance. These data suggest the applicability of the ITBCC criteria to GC.