Prognostic factors in the evaluation of colorectal liver metastases

Abstract

The liver is the most common site for the clinical appearance of hematogenous metastases from colorectal cancers. It is now accepted that surgical resection represents not only the best treatment but also a potentially curative one. Extensive resections are being performed routinely in many centers around the world. Practical problems that have arisen are the classification and staging of patients subjected to such treatments. Traditional staging would group all patients with hepatic rectal metastases in stage IV. In the current paper, we discuss the evolution of this classification according to our understanding of prognostic implications. We first discuss classifying these patients according to clinical prognostic factors, separating preoperative factors from those available only postoperatively. A discussion follows of the practical use of such clinical classification systems in daily care. We then suggest the potential future evolution of prognostic considerations, including the use of nomograms, molecular pathologic variables, and biologic scanning and the implications of response to neoadjuvant chemotherapy.