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 of1.15 (95%CI = 1.04–1.28,P= 0.007). The 10-yearcumulative riskofliver metastasis for the liver cirrhosis and the non-livercirrhosis group was 27.1 and 23.6%, respectively (P= 0.006). Forearly 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-yearcumulative risk 25.6 vs.16.6%,P= 0.009) both still had higherliver 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 nonliver 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.