结直肠癌（Colorectal cancer，CRC）在全球范围内位居第三位，且在2020年成为癌症相关死亡的第四大原因。近几十年来，转移性疾病的生存率略有改善，临床试验显示中位总生存期为24-30个月左右。这一进展可归因于化疗治疗与靶向治疗和免疫治疗的综合应用。尽管有着这些适度的改进，成功治疗晚期结直肠癌的主要障碍在于耐药性的发展，无论是固有的还是后天获得的，它仍然是治疗失败的主要原因。表观遗传学已经成为癌症的标志，为主要转录调控和基因组稳定性维持做出了贡献。因此，表观遗传学因素开始出现作为结直肠癌的诊断、预后和治疗反应预测的潜在临床生物标志物。近年来，许多研究已经调查了DNA甲基化、组蛋白修饰和染色质重塑对化疗治疗反应的影响。虽然有越来越多的证据表明它们在各种类型的癌症中具有重要作用，但染色质结构与结直肠癌治疗调控之间的确切关系仍然不明确。本综述的目的是综合总结2015年至2022年间最相关和广泛研究的表观遗传学相关机制，并探讨它们作为转移性疾病预测性生物标志物的潜在价值。版权所有 © 2023。由Elsevier Ltd.出版。

Colorectal cancer (CRC) ranks as the third most prevalent cancer globally and stands as the fourth leading cause of cancer-related fatalities in 2020. Survival rates for metastatic disease have slightly improved in recent decades, with clinical trials showing median overall survival of approximately 24-30 months. This progress can be attributed to the integration of chemotherapeutic treatments alongside targeted therapies and immunotherapy. Despite these modest improvements, the primary obstacle to successful treatment for advanced CRC lies in the development of chemoresistance, whether inherent or acquired, which remains the major cause of treatment failure. Epigenetics has emerged as a hallmark of cancer, contributing to master transcription regulation and genome stability maintenance. As a result, epigenetic factors are starting to appear as potential clinical biomarkers for diagnosis, prognosis, and prediction of treatment response in CRC. In recent years, numerous studies have investigated the influence of DNA methylation, histone modifications, and chromatin remodelers on responses to chemotherapeutic treatments. While there is accumulating evidence indicating their significant involvement in various types of cancers, the exact relationship between chromatin landscapes and treatment modulation in CRC remains elusive. This review aims to provide a comprehensive summary of the most pertinent and extensively researched epigenetic-associated mechanisms described between 2015 and 2022 and their potential usefulness as predictive biomarkers in the metastatic disease.Copyright © 2023. Published by Elsevier Ltd.