Liver Metastases from Colorectal Cancer: From Pathogenesis to Current Treatment

Colorectal cancer (CRC) remains one of the most frequently diagnosed malignancies worldwide, and colorectal cancer liver metastasis (CRLM) represents a major cause of CRC-related mortality. The liver provides a highly specialized environment that can be remodeled into a metastatic niche, where anatomical structure, metabolic properties, and immunological landscape collectively influence tumor cell survival, colonization, and outgrowth. Increasing evidence indicates that CRLM development is driven by dynamic interactions between tumor intrinsic programs and the hepatic tumor microenvironment(TME), involving epithelial plasticity, intercellular communication, stromal remodeling, and immune regulation. However, an integrated understanding that links metastatic initiation, hepatic niche formation, immune escape, and therapeutic intervention remain lacking. This review examines recent advances in the multistage progression of CRLM and discusses how immune tolerance, lymphocyte dysfunction, and suppressive cellular networks contribute to the establishment and maintenance of the CRLM. Finally, we review current clinical management strategies and emerging approaches, immunotherapy, and biomarker-guided precision treatment. By integrating mechanistic insights with clinical perspectives, this review aims to provide a conceptual framework for understanding CRLM progression and to identify potential directions for improving individualized therapeutic strategies.