Liver metastases are commonly detected in a range of malignancies including colorectal cancer (CRC), pancreatic cancer, melanoma, lung cancer and breast cancer, although CRC is the most common primary cancer that metastasizes to the liver. Interactions between tumour cells and the tumour microenvironment play an important part in the engraftment, survival and progression of the metastases. Various cells including liver sinusoidal endothelial cells, Kupffer cells, hepatic stellate cells, parenchymal hepatocytes, dendritic cells, resident natural killer cells as well as other immune cells such as monocytes, macrophages and neutrophils are implicated in promoting and sustaining metastases in the liver. Four key phases (microvascular, pre-angiogenic, angiogenic and growth phases) have been identified in the process of liver metastasis. Imaging modalities such as ultrasonography, CT, MRI and PET scans are typically used for the diagnosis of liver metastases. Surgical resection remains the main potentially curative treatment among patients with resectable liver metastases. The role of liver transplantation in the management of liver metastasis remains controversial. Systemic therapies, newer biologic agents (for example, bevacizumab and cetuximab) and immunotherapeutic agents have revolutionized the treatment options for liver metastases. Moving forward, incorporation of genetic tests can provide more accurate information to guide clinical decision-making and predict prognosis among patients with liver metastases.
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The authors declare no competing interests.
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- Left-sided tumours
Tumours that originate from the left descending colon.
- Right-sided tumours
Tumours that originate from the first part of the colon corresponding to the ascending colon.
- Conversion treatment
The use of cytotoxic drugs and/or chemotherapy that shrink the tumour to a level considered amenable to resection.
- Stage M1c melanoma
The cancer has spread to any other location that does not involve the central nervous system.
The state of having a single copy of a chromosome pair in contrast to the usual two copies found in diploid cells.
Invasion of cancer cells through the basement membrane into a blood or lymphatic vessel.
- Kupffer cells
Macrophages that are phagocytic and reside in sinusoids of the liver in proximity to the endothelial cells.
- Sinusoidal vessels
Low-pressure vascular channels that receive blood from terminal branches of the hepatic artery and portal vein at the periphery of lobules and deliver it into central veins.
- Space of Disse
The perisinusoidal space in the liver between a hepatocyte and a sinusoid.
Process in which innate immune cells, such as neutrophils, dendritic cells and monocytes, develop from a myeloid progenitor cell.
Specialized adhesive protein complexes that localize to intercellular junctions and are responsible for maintaining the mechanical integrity of tissues.
- Ring enhancement
Characteristic feature in CT, which represents a zonal area of viable tumour cells.
Approach to cancer treatment that aims to reduce the number of cancer cells via resection of the primary tumour or metastatic deposits.
- Future liver remnant
Volume of functional liver after resection
Type of structural protein that is expressed by the epithelial cells.
- Microsatellite instability
The condition of genetic hypermutability (predisposition to mutation) that results from impaired DNA mismatch repair.
- Hilar lymphadenopathy
Enlargement of lymph nodes at the hepatic hilum.
- Disease-free interval
Interval from the treatment of the primary tumour to the detection of metastases.
- Metachronous metastasis
Metastasis developed after a period of time from diagnosis of the primary tumour.
- Hepatic hilum
Anatomical region where bile ducts, hepatic arterial branches, portal vein branches, lymphatics and nerves enter or leave the liver.
- Heat-sink phenomenon
Phenomenon that limits ablation effectiveness when the target lesion is close (<1 cm) to a large blood vessel (≥3 mm diameter); the flowing blood causes a cooling effect, thereby reducing the ablation volume.
- Local control rate
Rate of controlling cancer growth at the local site of origin.
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Tsilimigras, D.I., Brodt, P., Clavien, PA. et al. Liver metastases. Nat Rev Dis Primers 7, 27 (2021). https://doi.org/10.1038/s41572-021-00261-6