Colorectal cancer liver metastasis (CRLM) and Liver Transplantation

Liver transplantation (LT) is emerging as a viable treatment option for colorectal cancer liver metastases (CRLM), offering promising outcomes for select patients. A large multicenter study analyzing 82 patients from 2006 to 2020 revealed favorable long-term survival rates, with 1-, 3-, and 5-year overall survival (OS) rates of 93.7%, 73.4%, and 54.9%, respectively. However, sex-based differences were significant, with female patients facing a fourfold higher mortality risk compared to males.

Several factors influence post-LT survival. Adverse prognostic indicators include elevated carcinoembryonic antigen (CEA >80 µg/L), KRAS mutations, right-sided primary tumors, large tumor nodules (>5.5 cm), and pN2-positive lymph nodes. Right-sided colorectal cancer, often seen in women, is linked to worse outcomes due to aggressive tumor biology. Women also experienced more frequent liver recurrences, which negatively impacted survival compared to lung-only recurrences.

Prior liver-directed therapies, such as resection or ablation, showed a protective effect, reducing post-transplant risks. Researchers propose that hormonal factors like oestrogens may influence immune tolerance and tumor progression in women, contributing to poorer liver recurrence outcomes.

The study calls for sex-aware prognostic models and refined LT selection criteria, integrating molecular profiling and hormonal factors to improve equity and precision in CRLM treatment through liver transplantation.