Background: Colorectal liver metastasis (CRLM) represents a major clinical challenge in oncology, affecting 25–50% of colorectal cancer patients and significantly impacting survival. While multimodal therapies—including surgical resection, systemic chemotherapy, and local ablative techniques—have improved outcomes, prognosis remains heterogeneous due to variations in tumor biology, patient factors, and institutional practices.Methods: This review synthesizes current evidence on prognostic factors influencing CRLM management, encompassing clinical (e.g., tumor burden, anatomic distribution, timing of metastases), biological (e.g., CEA levels, inflammatory markers), and molecular (e.g., RAS/BRAF mutations, MSI status, HER2 alterations) determinants.Results: Key findings highlight the critical role of molecular profiling in guiding therapeutic decisions, with RAS/BRAF mutations predicting resistance to anti-EGFR therapies and MSI-H status indicating potential responsiveness to immunotherapy. Emerging tools like circulating tumor DNA (ctDNA) and radiomics offer promise for dynamic risk stratification and early recurrence detection, while the gut microbiome is increasingly recognized as a modulator of treatment response.Conclusions: Despite advancements, challenges persist in standardizing resectability criteria and integrating multidisciplinary approaches. Current guidelines (NCCN, ESMO, ASCO) emphasize personalized strategies but lack granularity in terms of incorporating novel biomarkers. This exhaustive review underscores the imperative for the development of a unified, biomarker-integrated framework to refine CRLM management and improve long-term outcomes.
背景：结直肠癌肝转移（CRLM）是肿瘤学领域的一项重大临床挑战，影响25–50%的结直肠癌患者，并显著影响生存率。尽管多模式治疗——包括手术切除、全身化疗和局部消融技术——已改善了治疗结果，但由于肿瘤生物学特性、患者因素和机构实践的差异，预后仍存在异质性。 方法：本综述综合了当前关于影响CRLM管理的预后因素的证据，涵盖临床（如肿瘤负荷、解剖分布、转移时机）、生物学（如CEA水平、炎症标志物）和分子（如RAS/BRAF突变、MSI状态、HER2改变）决定因素。 结果：主要发现强调了分子谱分析在指导治疗决策中的关键作用，其中RAS/BRAF突变可预测对抗EGFR治疗的耐药性，而MSI-H状态则提示可能对免疫治疗有反应。新兴工具如循环肿瘤DNA（ctDNA）和影像组学为动态风险分层和早期复发检测提供了希望，同时肠道微生物组作为治疗反应的调节因子日益受到重视。 结论：尽管取得了进展，但在标准化可切除性标准和整合多学科方法方面仍存在挑战。当前指南（NCCN、ESMO、ASCO）强调个性化策略，但在整合新型生物标志物方面缺乏细节。本详尽综述强调，迫切需要建立一个统一的、整合生物标志物的框架，以优化CRLM管理并改善长期预后。
肿瘤(癌症)患者之家