Opinion Review
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2022; 28(6): 608-623
Published online Feb 14, 2022. doi: 10.3748/wjg.v28.i6.608
Is precision medicine for colorectal liver metastases still a utopia? New perspectives by modern biomarkers, radiomics, and artificial intelligence
Luca Viganò, Visala S Jayakody Arachchige, Francesco Fiz
Luca Viganò, Visala S Jayakody Arachchige, Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Rozzano 20089, MI, Italy
Luca Viganò, Visala S Jayakody Arachchige, Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20072, MI, Italy
Francesco Fiz, Nuclear Medicine, IRCCS Humanitas Research Hospital, Rozzano 20089, MI, Italy
Author contributions: Viganò L and Fiz F designed the study; Viganò L, Jayakody Arachchige VS, and Fiz F performed the literature review; Jayakody Arachchige VS, and Fiz F wrote the manuscript draft; Viganò L revised the manuscript; all authors reviewed the final version of the manuscript and approved it.
Supported by the Italian Association for Cancer Research, No. #2019−23822 (Luca Viganò).
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Luca Viganò, MD, PhD, Professor, Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano 20089, MI, Italy. luca.vigano@hunimed.eu
Received: June 22, 2021
Peer-review started: June 22, 2021
First decision: July 14, 2021
Revised: July 29, 2021
Accepted: January 20, 2022
Article in press: January 20, 2021
Published online: February 14, 2022
Processing time: 231 Days and 9.4 Hours
Abstract

The management of patients with liver metastases from colorectal cancer is still debated. Several therapeutic options and treatment strategies are available for an extremely heterogeneous clinical scenario. Adequate prediction of patients’ outcomes and of the effectiveness of chemotherapy and loco-regional treatments are crucial to reach a precision medicine approach. This has been an unmet need for a long time, but recent studies have opened new perspectives. New morphological biomarkers have been identified. The dynamic evaluation of the metastases across a time interval, with or without chemotherapy, provided a reliable assessment of the tumor biology. Genetics have been explored and, thanks to their strong association with prognosis, have the potential to drive treatment planning. The liver-tumor interface has been identified as one of the main determinants of tumor progression, and its components, in particular the immune infiltrate, are the focus of major research. Image mining and analyses provided new insights on tumor biology and are expected to have a relevant impact on clinical practice. Artificial intelligence is a further step forward. The present paper depicts the evolution of clinical decision-making for patients affected by colorectal liver metastases, facing modern biomarkers and innovative opportunities that will characterize the evolution of clinical research and practice in the next few years.

Keywords: Colorectal liver metastases; Biomarkers; Genetics; Immune infiltrate; Radiomics; Artificial Intelligence

Core Tip: The management of patients with colorectal liver metastases is challenging because the choice among different therapeutic options and strategies is not supported by strong evidence. A precision medicine approach has been an unmet need for a long time, but recent studies have opened new perspectives. In this paper, we will discuss new morphological approaches to assess tumor biology, the promising data from genetic analyses, the raising clinical relevance of the liver-tumor interface, and the potentialities of advanced imaging analysis and artificial intelligence. These are the keys to reach an effective personalized treatment in the near future.