Patients with Colorectal Liver Metastases (CRLM) now have a 5-year overall survival rate above 50% thanks to new systemic treatments paired with surgical therapy. For patients with unresectable CRLM, a wide range of liver-directed treatments have enhanced local disease control. Sadly, a sizeable percentage of patients who have curative-intent hepatectomy experience a disease recurrence. Traditional indicators do not properly risk-stratify and prognosticate CRLM patients. We now know much more about the pathophysiology and tumours microenvironment features of CRLM because to developments in molecular sequencing technologies over the past few decades. These investigations have uncovered biomarkers that could help guide treatment choices for CRLM patients. National and societal standards have taken actionable indicators including RAS and BRAF mutations, microsatellite instability/mismatch repair status, and tumours mutational burden into account. To assess their clinical value, other biomarkers, such as circulating tumours DNA and radiomic characteristics, are now being researched. Reliable biomarkers are required to help clinicians create patient-specific management strategies due to the abundance of therapeutic modalities and paucity of data on timing and sequencing.
