We identified genes related to 5-fluorouracil (5-FU) sensitivity in colorectal cancer and utilized these genes for predicting the 5-FU sensitivity of liver metastases. Eighty-one candidate genes involved in 5-FU resistance in gastric and colon cancer cell lines were previously identified using a cDNA microarray. In this study, the mRNA expression levels of these 81 selected genes and the genes of 5-FUrelated enzymes, including thymidylate synthase (TS), dihydropyrimidine dehydrogenase (DPD) and orotate phosphoribosyltransferase (OPRT), were measured using real-time quantitative RT-PCR assays of surgically resected materials from primary colorectal tumors in 22 patients. Clinical responses were estimated by evaluating the effects of 5-FU-based hepatic artery injection (HAI) chemotherapy for synchronous liver metastases. Four genes (TNFRSF1B, SLC35F5, NAG-1 and OPRT) had significantly different expression profiles in 5-FU-nonresponding and responding tumors (p < 0.05). A ''Response Index'' system using three genes (TNFRSF1B, SLC35F5 and OPRT) was then developed using a discriminate analysis; the results were well correlated with the individual chemosensitivities. Among the 11 cases with positive scores in our response index, 9 achieved a reduction in their liver metastases after 5-FU-based chemotherapy, whereas only 1 of the 11 cases with negative scores responded well to chemotherapy. Our ''Response Index'' system, consisting of TNFRSF1B, SLC35F5 and OPRT, has great potential for predicting the efficacy of 5-FU-based chemotherapy against liver metastases from colorectal cancer. ' 2006 Wiley-Liss, Inc.Key words: 5-fluorouracil; chemosensitivity; colorectal cancer; liver metastasis; prediction Colorectal cancer is one of the most common malignancies and the second cause of death from cancer in the United States. 1 Recent improvements in early diagnosis and surgical therapy have facilitated the detection of early colorectal cancer and have contributed to a constantly decreasing death rate 1 ; however, some patients remain undiagnosed until their tumor has reached an advanced stage. The prognosis of patients with colorectal cancer depends on the stage of the disease. Patients with Dukes A disease have a good prognosis, but those with Dukes D disease, especially those with hepatic metastases, have a very poor prognosis.2 Furthermore, despite the complete curative resection of the primary tumor, many patients develop local or distant recurrences, and distant recurrences and metastatic tumors remain a major cause of death for patients with colorectal cancer.2 Therefore, the most efficacious strategy for improving surgical outcome in patients with colorectal cancer is to control distant recurrences and metastases effectively using neoadjuvant and adjuvant chemotherapy.5-Fluorouracil (5-FU) is the most frequently used chemotherapeutic agent for neoadjuvant and adjuvant chemotherapy against metastatic colorectal cancer. However, despite combined chemotherapy with 5-FU and other agents (Cisplatin, Leucovorin or Oxaliplatin...