Effect of liver cirrhosis on metastasis in colorectal cancer patients: a nationwide population-based cohort study.
OBJECTIVE
The aim of this study is to evaluate the liver metastasis risk among colorectal cancer patients with liver cirrhosis.


METHODS
This was a nationwide population-based cohort study of 2973 newly diagnosed colorectal cancer patients with liver cirrhosis and 11 892 age-sex matched controls enrolled in Taiwan between 2000 and 2010. The cumulative risk by Kaplan-Meier method, hazard ratio by the multivariate Cox proportional model and the incidence density were evaluated.


RESULTS
The median time interval from the colorectal cancer diagnosis to the liver metastasis event was 7.42 months for liver cirrhosis group and 7.67 months for non-liver cirrhosis group. The incidence density of liver metastasis was higher in the liver cirrhosis group (61.92/1000 person-years) than in the non-liver cirrhosis group (47.48/1000 person-years), with a significantly adjusted hazard ratio of 1.15 (95% CI = 1.04-1.28, P = 0.007). The 10-year cumulative risk of liver metastasis for the liver cirrhosis and the non-liver cirrhosis group was 27.1 and 23.6%, respectively (P = 0.006). For early cancer stage with locoregional disease patients receiving surgery alone without adjuvant anti-cancer treatments, patients with liver cirrhosis (10-year cumulative risk 23.9 vs. 15.7%, P < 0.001) or cirrhotic symptoms (10-year cumulative risk 25.6 vs. 16.6%, P = 0.009) both still had higher liver metastasis risk compared with their counterparts. For etiologies of liver cirrhosis, the 10-year cumulative risk for hepatitis B virus and hepatitis C virus, hepatitis B virus, hepatitis C virus, other causes and non-liver cirrhosis were 29.5, 28.9, 27.5, 26.7 and 23.4%, respectively, (P = 0.03).


CONCLUSIONS
Our study found that liver metastasis risk was underestimated and even higher in colorectal cancer patients with liver cirrhosis.
Department of Radiation Oncology, Buddhist Dalin Tzu Chi Hospital, Chiayi School of Medicine, Tzu Chi University, Hualien Department of Public Health, College of Medicine, National Cheng Kung University, Tainan.
Wen-Yen
WY
Chiou
School of Medicine, Tzu Chi University, Hualien Department of Surgery, Buddhist Dalin Tzu Chi Hospital, Chiayi.
Chun-Ming
CM
Chang
School of Medicine, Tzu Chi University, Hualien Division of Gastroenterology, Department of Internal Medicine, Buddhist Dalin Tzu Chi Hospital, Chiayi.
Kuo-Chih
KC
Tseng
Department of Radiation Oncology, Buddhist Dalin Tzu Chi Hospital, Chiayi School of Medicine, Tzu Chi University, Hualien.
Shih-Kai
SK
Hung
Department of Radiation Oncology, Buddhist Dalin Tzu Chi Hospital, Chiayi School of Medicine, Tzu Chi University, Hualien.
Hon-Yi
HY
Lin
School of Medicine, Tzu Chi University, Hualien Division of Nephrology, Department of Internal Medicine, Buddhist Dalin Tzu Chi Hospital, Chiayi.
Yi-Chun
YC
Chen
School of Medicine, Tzu Chi University, Hualien Division of Hematology-Oncology, Department of Internal Medicine, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan.
Yu-Chieh
YC
Su
School of Medicine, Tzu Chi University, Hualien Division of Gastroenterology, Department of Internal Medicine, Buddhist Dalin Tzu Chi Hospital, Chiayi.
Chih-Wei
CW
Tseng
Department of Radiation Oncology, Buddhist Dalin Tzu Chi Hospital, Chiayi.
Shiang-Jiun
SJ
Tsai
Department of Radiation Oncology, Buddhist Dalin Tzu Chi Hospital, Chiayi School of Medicine, Tzu Chi University, Hualien rt@url.com.tw armstrong_washington@hotmail.com.
Moon-Sing
MS
Lee
Department of Public Health, College of Medicine, National Cheng Kung University, Tainan rt@url.com.tw armstrong_washington@hotmail.com.
Chung-Yi
CY
Li
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D015994:Incidence; D007223:Infant; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D008113:Liver Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012107:Research Design; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
colorectal cancer; liver cirrhosis; liver metastasis