Tumor Microenvironment in Metastatic Colorectal Cancer: The Arbitrator in Patients’ Outcome

Abstract

Colorectal cancer (CRC) is one of the most common cancers in western countries. Its mortality rate varies greatly, depending on the stage of the disease. The main cause of CRC mortality is metastasis, which most commonly affects the liver. The role of tumor microenvironment in tumor initiation, progression and metastasis development has been widely studied. In this review we summarize the role of the tumor microenvironment in the liver pre-metastatic niche formation, paying attention to the distant cellular crosstalk mediated by exosomes. Moreover, and based on the prognostic and predictive capacity of alterations in the stromal compartment of tumors, we describe the role of tumor microenvironment cells and related liquid biopsy biomarkers in the delivery of precise medication for metastatic CRC. Finally, we evaluate the different clinical strategies to prevent and treat liver metastatic disease, based on the targeting of the tumor microenvironment. Specifically, targeting angiogenesis pathways and regulating immune response are two important research pipelines that are being widely developed and promise great benefits.

Weight Loss During Neoadjuvant Therapy Is Associated With Poor Response Among the Patients With Gastrointestinal Cancer: A Propensity Score Matching Analysis

“…Precise medication can currently reduce the complications and occurrence of tumor-associated cachexia for cancer patients during neoadjuvant treatment. 32 , 33 BMI changes after NAT can be used as a basis, combined with imaging assessments and biochemical indicators, to evaluate the efficacy of neoadjuvant therapy in GC patients before surgery. Compared with previously published reports, a decline in BMI was positively associated with preoperative treatment efficacy and survival in our cohort.…”

Clinical application and detection techniques of liquid biopsy in gastric cancer

“…Therefore, researchers have also developed more content-rich biomarkers to complement them. Currently, tumor-educated platelets, circulating endothelial cells, and tumor microenvironment components have been identified as liquid biomarkers for biopsy [226][227][228], but no application of these three markers in GC diagnosis has been found. Therefore, more research is needed to complement the effective GC markers and find new markers that can compensate for the shortcomings of current biomarkers and thus provide clinical guidance.…”

Liquid Biopsies in Colorectal Liver Metastases: Towards the Era of Precision Oncologic Surgery

“…Several chemokines, including CXCR4, CCR4, CCR7, and CCR9, also play a significant role in the migration of metastatic cells into the circulation [ 20 ]. The tumor microenvironment (TME) is crucial in tumor progression and analysis of TME though liquid biopsies can provide significant information on prognosis and response to treatment [ 21 ]. Of note, the detection of CTCs among patients who have undergone primary tumor resection might indicate that tumor cells recirculate from secondary metastatic sites into the bloodstream and is currently considered a poor prognostic indicator [ 15 , 22 ].…”