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.
School of Medicine, Tzu Chi University, Hualien Department of Surgery, Buddhist Dalin Tzu Chi Hospital, Chiayi.
Jpn J Clin Oncol. 2015 Feb;45(2):160-8. doi: 10.1093/jjco/hyu178. Epub 2014 Nov 6.
The aim of this study is to evaluate the liver metastasis risk among colorectal cancer patients with liver cirrhosis.
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.
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).
Our study found that liver metastasis risk was underestimated and even higher in colorectal cancer patients with liver cirrhosis.
本研究旨在评估肝硬化合并结直肠癌患者的肝转移风险。
这是一项基于人群的全国性队列研究，纳入了 2000 年至 2010 年间在台湾确诊的 2973 例肝硬化合并结直肠癌患者和 11892 例年龄性别匹配的对照组。采用 Kaplan-Meier 法评估累积风险，采用多因素 Cox 比例模型评估风险比，采用发病率密度评估发病率。
肝硬化组从结直肠癌诊断到肝转移事件的中位时间间隔为 7.42 个月，非肝硬化组为 7.67 个月。肝硬化组的肝转移发病率（61.92/1000 人年）高于非肝硬化组（47.48/1000 人年），调整后的风险比为 1.15（95%CI=1.04-1.28，P=0.007）。肝硬化组和非肝硬化组的 10 年累积肝转移风险分别为 27.1%和 23.6%（P=0.006）。对于仅接受手术治疗且未接受辅助抗癌治疗的早期癌症局部疾病患者，肝硬化（10 年累积风险 23.9%比 15.7%，P<0.001）或肝硬化症状（10 年累积风险 25.6%比 16.6%，P=0.009）的患者仍有更高的肝转移风险。对于肝硬化的病因，乙型肝炎病毒和丙型肝炎病毒、乙型肝炎病毒、丙型肝炎病毒、其他原因和非肝硬化的 10 年累积风险分别为 29.5%、28.9%、27.5%、26.7%和 23.4%（P=0.03）。
本研究发现，肝硬化合并结直肠癌患者的肝转移风险被低估，甚至更高。
