Oncologic and surgical outcomes in colorectal cancer patients with liver cirrhosis: A propensity-matched study

Abstract

The management of colorectal cancer in patients with liver cirrhosis requires a thorough understanding of both diseases. This study evaluated the effect of liver cirrhosis on oncologic and surgical outcomes and prognostic factors in colorectal cancer patients. Fifty-five consecutive colorectal cancer patients with liver cirrhosis underwent colorectal resection (LC group). Using a prospectively maintained database, these patients were matched 1:4 using propensity scoring with R programming language, package "MatchIt" and "optmatch" by sex, age, cancer location, and tumor stage with 220 patients without liver cirrhosis (non-LC group), resulting in 275 patients. The 5-year overall survival (OS) was significantly worse in the LC group than in the non-LC group (46.7% vs. 76.2% respectively, P < 0.001); however, the 5-year proportion of recurrence free (PRF) rates were similar (73.1% vs. 84.5% respectively, P = 0.094). On multivariate analysis of the LC group, tumor-node-metastasis (TNM) stage ≥III disease, venous invasion, and a model for end-stage liver disease plus serum sodium (MELD-Na) score >10 were prognostic factors for OS. However, the OS was not different between the LC group with MELD-Na score ≤10 and the non-LC group (5-year OS rate, TNM stage ≤II, 85.7 vs 89.5%, p = 0.356; TNM stage ≥III, 41.1 vs 66.2%, p = 0.061). Colorectal cancer patients with liver cirrhosis have poorer OS compared to those without liver cirrhosis; however, the PRF rates are similar. It might be due to the mortality from the liver, and surgical treatment should be actively considered for patients with MELD-Na score <10.

NOD‐like receptor C4 Inflammasome Regulates the Growth of Colon Cancer Liver Metastasis in NAFLD

“…Although liver metastasis can occur in CRC patients without NAFLD, a recent large prospective human cohort analyzing 2,715 CRC patients with liver metastasis as well as other retrospective studies have suggested that the patients with NAFLD have an increased risk of liver metastasis and for the recurrence of liver metastasis after resection, when compared with patients without NAFLD . Moreover, higher recurrence rate of liver metastasis in patients with fibrosis have also been reported in recent studies . However, previous studies underestimated the risk of liver metastasis or have reported contradictory results in patients with underlying fatty liver and fibrosis .…”

Meta-analysis of short- and long-term outcomes after pure laparoscopic versus open liver surgery in hepatocellular carcinoma patients

“…Moreover, operations for hepatocellular carcinoma (HCC) in patients with liver cirrhosis and portal hypertension are considered difficult and may be associated with relatively high morbidity [ 12 ]. It has been proved that patients with liver cirrhosis have worse overall outcomes and a higher perioperative complication rate [ 13 , 14 ].…”

Hypertriglyceridaemia as a risk factor for critical care admission in acute pancreatitis: A prospective study

“…A retrospective observational study of 582 patients with acute pancreatitis in 2016 found that a serum triglyceride concentration !2.26 mmol/L in acute pancreatitis was an independent predictor of admission to ICU, and developing local and systemic complications [5]. Similarly, in a large retrospective study of 1539 patients with acute pancreatitis, hypertriglyceridaemia was associated with greater severity and poorer prognosis of acute pancreatitis, persistent systemic inflammatory response syndrome and increased ICU admission [6]. Increased need for ICU admission and an increased overall LOS have also been reported previously [5].…”

“…Some studies have reported that regardless of the underlying primary aetiology of acute pancreatitis, concurrent hypertriglyceridaemia is associated with greater severity, more frequent development of persistent organ failure and poorer outcomes [4]. Others have suggested that hypertriglyceridaemia is associated with aggravation of acute pancreatitis, increased local and systemic complications, and increased admission to ICU [5,6]. A single centre study of 50 patients with severe hypertriglyceridaemia and acute pancreatitis described a mortality of 15% in such patients [7].…”