Abstract
Background: The purpose of this study was to investigate the effect of non-alcoholic fatty liver disease (NAFLD) on the risk of synchronous colorectal liver metastasis (synCRLM).Methods: A retrospective analysis was performed on 451 consecutive patients with newly diagnosed colorectal cancer (CRC) from January 2014 to January 2019. According to the presence of NAFLD, the CRC patients were divided into two groups, NAFLD group (60 cases) and the control group (391 cases). The clinicopathological features and the prevalence of synCRLM between the two groups were compared. Logistic regression analysis was used to analyze the risk factors of synCRLM. Different non-invasive liver fibrosis scoring models were used to evaluate the effect of advanced fibrosis and cirrhosis stage in NAFLD on the prevalence of synCRLM.Results: The prevalence of synCRLM was significantly higher in patients with NAFLD than that in patients without NAFLD (18.33 vs. 7.42%; χ2 = 7.669, P = 0.006). A logistic regression analysis indicated that NAFLD, CEA, CA19-9, and lymph node status were risk factors for synCRLM, and NAFLD showed the highest hazard ratio (3.930 [95% confidence interval: 1.616 ~ 9.560]). In NAFLD patients, both fibrosis-4 index (FIB-4) and NAFLD fibrosis score (NFS) were significantly lower in those with synCRLM compared to those without synCRLM [FIB-4: 1.246 (0.833 ~ 1.276) vs. 1.436 (1.016 ~ 2.699), Z = −2.130, P = 0.033; NFS: −1.282 (−2.407 ~ −0.262) vs. −0.255 (−1.582 ~ 0.755), Z = −2.302, P = 0.021; Mann-Whitney test].Conclusion: NAFLD may be associated with increased liver metastasis, and for NAFLD-related advanced liver fibrosis and cirrhosis may be associated with reduced synchronous liver metastasis in CRC patients. However, the correlation between simple steatosis and steatohepatitis remains to be further determined. Certain factors such as NAFLD, lymph node metastasis, elevated levels of preoperative CEA and CA19-9 are suggesting a high risk of synCRLM.
Highlights
Colorectal cancer (CRC) is one of the most well-established malignancies of the digestive system, which is the third most common malignant tumor in the world and the fourth most frequent cause of cancer-related deaths
The inclusion criteria were as follows: [1] all patients confirmed as CRC histopathologically, [2] did not receive any surgery, interventional treatment, chemotherapy or radiotherapy in other hospitals before admission, [3] for the purpose of detecting the presence of non-alcoholic fatty liver disease (NAFLD) and distant organ metastasis, all patients screened by preoperative chest, abdominal and pelvic regions imaging, such as ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI), [4] complete medical records
60 (13.30%) patients were diagnosed with NAFLD, and 391 (86.70%) patients were regarded as the control group
Summary
Colorectal cancer (CRC) is one of the most well-established malignancies of the digestive system, which is the third most common malignant tumor in the world and the fourth most frequent cause of cancer-related deaths. Distant metastasis is the most important independent risk factors for poor prognosis in CRC patients. Previous studies have reported that more than 50% of CRC patients will develop liver metastasis in the process of the disease, about 14–25% of CRC patients are found to have synchronous liver metastasis at the time of diagnosis, and about 10–25% of CRC patients develop metachronous liver metastasis during follow-up after the initiation of treatment. Whether liver metastasis occurs or not is the crucial point affecting the prognosis of CRC, and understanding the risk factors of liver metastasis may be one of the effective strategies to reduce the circumstance of liver metastasis. The purpose of this study was to investigate the effect of non-alcoholic fatty liver disease (NAFLD) on the risk of synchronous colorectal liver metastasis (synCRLM)
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