Objective Colorectal cancer (CRC) is one of the most prevalent malignant tumors worldwide, posing a significant threat to human health. Tumor budding (TB), as a critical pathological feature of CRC, is closely associated with tumor invasion, metastasis, and prognosis. MethodsThis review synthesizes recent advances in TB research within CRC. Through a systematic analysis of the literature,it focuses on elucidating the pathological processes and molecular mechanisms underlying TB formation,highlighting its complex interplay with the tumor microenvironment. The review also summarizes methodologies for TB counting and grading, spanning from conventional histopathological evaluation to innovative approaches leveraging radiomics and artificial intelligence. ResultsTB play an essential role in clinical decision-making for CRC patients, demonstrating how TB grade influences surgical strategy selection and the planning of neoadjuvant and adjuvant therapies. Additionally, TB is also a key prognostic indicator of CRC, high-grade TB being consistently associated with increased risk of recurrence and reduced survival rate. Future research should further unravel the molecular mechanisms of TB, refine TB assessment methodologies,and validate the clinical utility of TB in personalized treatment strategies through multicenter trials. These efforts are expected to improve therapeutic outcomes and prognosis for CRC patients.
