PROGNOSTIC AND PREDICTIVE VALUE OF TUMOR BUDDING, LYMPHOVASCULAR INVASION, AND PERINEURAL INVASION IN COLORECTAL CARCINOMA.

BACKGROUND: Colorectal carcinoma (CRC) remains one of the most common malignancies worldwide and a leading cause of cancer-related mortality. Accurate prediction of recurrence is essential for risk stratification and individualized postoperative management. This study aimed to evaluate the prognostic and predictive significance of tumor budding (TB), lymphovascular invasion (LVI), and perineural invasion (PNI) in colorectal carcinoma. METHODS: A retrospective cohort study was conducted including patients treated at the Clinic of Abdominal Surgery and the Department of Pathology, University Clinical Center of Kosovo (UCCK), between January 2020 and June 2025. Follow-up data collection continued until December 2025, and only patients with a minimum follow-up duration of 6 months were included in the final analysis. Clinical, surgical, and histopathological data were collected, including TB, LVI, and PNI status. Statistical analysis included descriptive methods, chi-square test, binary logistic regression, receiver operating characteristic (ROC) curve analysis with area under the curve (AUC), and Kaplan-Meier disease-free survival (DFS) analysis with the log-rank test. RESULTS: High tumor budding (BD3) was identified in 29.2% of patients, LVI in 34.1%, and PNI in 26.7%. At least one invasive histopathological factor was present in 48.6% of the cohort. All three markers were significantly associated with disease recurrence (p<0.001). Multivariate logistic regression demonstrated that independent predictors of recurrence were LVI (OR 4.72; 95% CI 2.46-9.03), PNI (OR 3.91; 95% CI 1.98-7.72), and TB (OR 3.24; 95% CI 1.67-6.29). LVI showed the highest predictive accuracy in ROC analysis (AUC = 0.781). Kaplan-Meier survival analysis demonstrated significantly shorter median disease-free survival (DFS) in patients with one or more positive invasive histopathological factors compared with patients without such factors. Median DFS was 22.4 months (95% CI: 18.7-26.1) versus 35.1 months (95% CI: 31.4-38.8), respectively (log-rank p<0.001) Conclusions: Tumor budding, lymphovascular invasion, and perineural invasion are independent prognostic markers in colorectal carcinoma. Among them, LVI demonstrated the strongest predictive value for recurrence. Routine incorporation of these parameters into pathological reports may improve prognostic assessment and support therapeutic decision-making.