Prognostic value of primary tumor site in surgery for colorectal liver metastases

Table 2 The clinical and biologic profile of right-sided colorectal liver metastases

Clinical domain	Manifestations in right-sided CRLM[1]	Proposed biological driver	Actionable clinical response
Metastatic aggression	High lymph node metastasis rate; > 55% 12-month recurrence	CMS4 mesenchymal phenotype; enhanced invasive capacity	Enhanced staging; pursuit of wider surgical margins
Systemic environment	Elevated D-dimer; hypoalbuminemia	Tumor-induced hypercoagulability; cancer-associated systemic inflammation	Consider perioperative anticoagulation; mandatory prehabilitation
Therapeutic resistance	High rate of poor neoadjuvant response	Distinct molecular drivers (e.g., BRAF); enriched chemoresistant pathways	First-line therapy intensification; early biomarker integration
Ultimate outcome	Diminished median overall survival	Synergistic effect of an aggressive biologic phenotype	Classify as “ultra-high risk”; implement intensive, personalised surveillance

CRLM: Colorectal liver metastases; CMS4: Consensus molecular subtype 4; BRAF: V-Raf murine sarcoma viral oncogene homolog B.