尽管对结直肠癌（CRC）的了解进行了广泛的研究和改进，但其转移形式仍然构成重大挑战，这主要是由于有限的治疗选择和不良的预后。本综述讨论了人们对转移性结直肠癌 (mCRC) 的新关注，尽管转移性结直肠癌具有致命性，但与原发性结直肠癌相比，历来对其研究不足。我们深入研究两个关键方面：促进结直肠癌转移的分子和细胞决定因素以及指导转移性疾病进化的原则。首先，我们检查了 CRC 转移所必需的基因改变，将其与晚期 CRC 的临床显着特征联系起来。随后，我们仔细研究了细胞异质性和可塑性在转移扩散和治疗抵抗中的作用。最后，我们探讨肿瘤微环境如何影响转移性疾病，强调基质基因程序和免疫环境的影响。这些领域正在进行的研究非常重要，因为其未来影响预计将彻底改变转移性结直肠癌患者的治疗方法，有望为他们的生存带来光明的前景。© 2024。施普林格自然有限公司。

Despite extensive research and improvements in understanding colorectal cancer (CRC), its metastatic form continues to pose a substantial challenge, primarily owing to limited therapeutic options and a poor prognosis. This Review addresses the emerging focus on metastatic CRC (mCRC), which has historically been under-studied compared with primary CRC despite its lethality. We delve into two crucial aspects: the molecular and cellular determinants facilitating CRC metastasis and the principles guiding the evolution of metastatic disease. Initially, we examine the genetic alterations integral to CRC metastasis, connecting them to clinically marked characteristics of advanced CRC. Subsequently, we scrutinize the role of cellular heterogeneity and plasticity in metastatic spread and therapy resistance. Finally, we explore how the tumour microenvironment influences metastatic disease, emphasizing the effect of stromal gene programmes and the immune context. The ongoing research in these fields holds immense importance, as its future implications are projected to revolutionize the treatment of patients with mCRC, hopefully offering a promising outlook for their survival.© 2024. Springer Nature Limited.