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Improving Outcomes in Resected Colorectal Liver Metastases: Risk-Stratified Chemotherapy and Aggressive Integration of Thermal Ablation

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Metastasis".

Deadline for manuscript submissions: 31 July 2026 | Viewed by 1254

Special Issue Editor

Department of Surgery, Yamaga City Medical Center, Kumamoto 860-8555, Japan
Interests: colorectal liver metastases; hepatocellular carcinoma; liver resection; conversion surgery; tumor biomarkers; interventional radiology; functional liver assessment; personalized multimodal treatment

Special Issue Information

Dear Colleagues,

Indications for liver resection in patients with colorectal liver metastases (CRLM) have expanded substantially, and long-term survival has improved dramatically with advances in surgical techniques and systemic therapy. Nevertheless, postoperative recurrence remains frequent even after curative-intent resection. This underscores the need for refined, individualized treatment strategies rather than uniformly applied perioperative approaches.

Recurrence risk is driven not only by tumor burden but also by biological aggressiveness. Tumor markers such as carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9), together with RAS mutation status, have demonstrated prognostic relevance, while circulating tumor DNA (ctDNA) provides insights into minimal residual disease and early relapse. Integrating these serological and molecular biomarkers enables more accurate risk stratification and optimized selection for preoperative or perioperative chemotherapy, while avoiding overtreatment in low-risk populations.

In parallel, thermal ablation has evolved beyond a palliative modality and is increasingly incorporated into curative-intent strategies. Aggressive integration of thermal ablation, combined with hepatectomy or applied selectively, may enhance local control while preserving functional liver reserve.

This Special Issue highlights recent advances in biomarker-driven, risk-stratified chemotherapy and the aggressive integration of thermal ablation to improve outcomes in patients with resected CRLM, fostering personalized and multimodal treatment strategies.

Dr. Toru Beppu
Guest Editor

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Keywords

  • colorectal liver metastases (CRLM)
  • liver resection
  • systemic chemotherapy
  • recurrence-risk stratification
  • carcinoembryonic antigen (CEA)
  • carbohydrate antigen 19-9 (CA19-9)
  • circulating tumor DNA (ctDNA)
  • RAS mutation
  • thermal ablation

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Published Papers (2 papers)

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Review

12 pages, 260 KB  
Review
Prognostic Role of CA19-9 in Patients Undergoing Hepatectomy for Colorectal Liver Metastases
by Toshiro Masuda, Toru Beppu, Tatsunori Miyata, Hirohisa Okabe, Katsunori Imai, Katsunori Sakamoto, Yuji Miyamoto and Hiromitsu Hayashi
Cancers 2026, 18(10), 1624; https://doi.org/10.3390/cancers18101624 - 17 May 2026
Viewed by 244
Abstract
Carbohydrate antigen 19-9 (CA19-9) is widely used as a tumor marker in gastrointestinal malignancies; however, its clinical significance in patients undergoing resection for colorectal liver metastases (CRLM) remains unclear. This review summarizes current evidence regarding the prognostic value of CA19-9 in CRLM, with [...] Read more.
Carbohydrate antigen 19-9 (CA19-9) is widely used as a tumor marker in gastrointestinal malignancies; however, its clinical significance in patients undergoing resection for colorectal liver metastases (CRLM) remains unclear. This review summarizes current evidence regarding the prognostic value of CA19-9 in CRLM, with particular emphasis on its role compared with carcinoembryonic antigen (CEA) and its integration into modern prognostic models. Across multiple cohort studies, elevated preoperative CA19-9 levels have consistently been associated with worse recurrence-free and overall survival after hepatectomy. In several multivariable analyses, CA19-9 emerged as a significant prognostic factor whereas CEA did not. CA19-9 has also been incorporated into several prognostic scoring systems and nomograms, including the JSHBPS nomogram (Beppu score) and the Imai nomogram, highlighting its value as a surrogate marker of potentially unfavorable tumor biology. Reported cutoff values vary widely across studies, ranging from near-normal levels (34–37 U/mL) to higher thresholds (100–200 U/mL), and the optimal cutoff remains uncertain. In addition to its role as a categorical risk factor, dynamic changes in CA19-9 during preoperative chemotherapy may provide additional prognostic information. Routine assessment of CA19-9 together with CEA at CRLM diagnosis and during perioperative management may improve risk stratification and guide personalized multidisciplinary treatment strategies. Full article
14 pages, 254 KB  
Review
Current and Future Perspectives of Adjuvant Therapy for Resected Colorectal Liver Metastases
by Kozo Kataoka, Kei Kimura, Ayako Imada, Kazuma Ito, Zhenxin Rao, Yuko Fukumoto, Jihyung Song, Yuki Horio, Ryuichi Kuwahara, Motoi Uchino, Takayuki Yoshino, Eiji Oki, Yukihide Kanemitsu and Masataka Ikeda
Cancers 2026, 18(8), 1188; https://doi.org/10.3390/cancers18081188 - 8 Apr 2026
Viewed by 703
Abstract
The liver is the most common site of metastatic disease in patients with colorectal cancer. However, the multidisciplinary management of colorectal liver metastases (CLMs) remains suboptimal. Over the past several decades, numerous randomized trials have evaluated the efficacy of adjuvant chemotherapy following CLM [...] Read more.
The liver is the most common site of metastatic disease in patients with colorectal cancer. However, the multidisciplinary management of colorectal liver metastases (CLMs) remains suboptimal. Over the past several decades, numerous randomized trials have evaluated the efficacy of adjuvant chemotherapy following CLM resection, revealing improvements in disease-free survival. Nevertheless, these studies have not consistently demonstrated benefits in overall survival, resulting in controversy with regard to the role of routine postoperative chemotherapy. Circulating tumor DNA (ctDNA) has recently emerged as a promising biomarker for detecting molecular residual disease after surgery. Multiple studies have consistently shown that postoperative ctDNA positivity is strongly associated with inferior recurrence-free survival and overall survival in patients with colorectal cancer. In addition to its prognostic value, ctDNA may also assist in guiding postoperative therapeutic decisions. In prospective observational studies of CLM, adjuvant chemotherapy provided potential clinical benefits primarily in patients with ctDNA-positive disease, whereas limited benefits were observed in ctDNA-negative patients. These findings suggest that ctDNA-based detection of molecular residual disease may aid in developing a framework for risk-adapted postoperative management after CLM resection. However, several challenges remain, including the identification of an optimal treatment regimen for ctDNA-positive patients and the improvement of ctDNA assay sensitivity. Ongoing biomarker-driven clinical trials may clarify whether ctDNA-guided strategies can improve patient selection and clinical outcomes following curative resection of CLM. Full article
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