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August 30, 2026Critical Reviews in Oncology/HematologyOpen Access

Prognostic models and predictors of recurrence in resectable colorectal liver metastases: A systematic review and meta-analysis

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Authors

LML ManganaroFIT Consulting (Italy)TRTommaso RussoVita-Salute San Raffaele UniversityLNLisa NovelloUniversity of Sussex

Discussion

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Implication

Systematic review and meta-analysis reveals predictors of recurrence after colorectal liver metastases resection, highlighting circulating tumor DNA as a critical biomarker.

Key Points

  • To systematically review prognostic models for recurrence following curative-intent locoregional treatment of colorectal liver metastases and synthesize clinical, molecular, and treatment-related predictors of recurrence-free survival.
  • Conducted a systematic review and meta-analysis of 293 studies spanning 26 years of literature, comprising 85,150 patients in development cohorts and 5,549 patients in validation cohorts.
  • Evaluated model methodologies, performance reporting, validation rates, and quantitatively pooled hazard ratios for predictors of recurrence-free survival.
  • Postoperative circulating tumor DNA positivity was identified as the strongest predictor of recurrence (HR 4.78), alongside postoperative carcinoembryonic antigen > 5 ng/mL (HR 2.79) and poor RECIST response to neoadjuvant therapy (HR 2.76).
  • Positive resection margins (HR 1.73), primary lymph node positivity (HR 1.58), and multiple liver metastases (HR 1.49) were significantly associated with increased recurrence, whereas adjuvant and peri-operative systemic therapies correlated with lower risk.
  • External validation was performed in only 33 of 293 studies, with Cox proportional hazards regression remaining the dominant modeling strategy over artificial intelligence and machine learning techniques.

Cite This Study

Manganaro et al. (2026) studied this question.

synapsesocial.com/papers/6aab9ac984d0a0b77ba8b7aehttps://doi.org/10.1016/j.critrevonc.2026.105572
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