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. 2021 Feb 25;71(2):322–332. doi: 10.1136/gutjnl-2020-323703

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© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Phylogenetic reconstruction of metastatic spread in CRC. (A–F) The clinical course is shown from the time of surgical resection of primary tumours to death or last follow-up. A new metastasis clinically observed is annotated as hollow circles. Rhombus indicates the use of neoadjuvant therapy. A hollow square indicates synchronous lesions. Time intervals between each event are shown in months. Systemic treatments are indicated in the intervals. A schematic diagram was provided for each case to demonstrate the origin site of each sample. All trees were reconstructed with phylogenomic methods and scaled to demonstrate the metastatic pattern. Seeding events that gave rise to primary tumour (PRM), regional lymph node metastasis (RLN), liver metastasis (LIM), lung metastasis (LUM), thoracic lymph node metastasis (TLN) are shaded in red, green, blue, orange and purple, respectively. Putative driver gene mutations are annotated on the trunk or branches of the trees. The length of the dashed line is not taken into account in the scale bar. BVZ, bevacizumab; CRC, colorectal cancer; CTX. cetuximab; FOLFIRI, 5-fluorouracil, leucovorin, irinotecan; FOLFOX, 5-fluorouracil, leucovorin, oxaliplatin; XELIRI, capecitabine plus irinotecan; XELOX, capecitabine plus oxaliplatin.