Shin Nari, Han Eon Chul, Won Sungho, Ryoo Seung-Bum, Choe Eun Kyung, Park Byung Kwan, Park Kyu Joo
Department of Public Health Sciences and Institute of Health and Environment, Seoul National University, Seoul, Korea.
Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea.
Ann Surg Treat Res. 2020 Aug;99(2):82-89. doi: 10.4174/astr.2020.99.2.82. Epub 2020 Jul 31.
The management of patients with colorectal cancer (CRC) who have liver cirrhosis (LC) requires a thorough understanding of both diseases; however, the prognoses and postoperative outcomes of such patients remain understudied. We investigated the effect of LC on surgical and oncologic outcomes in patients with CRC, and identified prognostic factors.
We analyzed 453 patients with CRC and LC (CRC-LC group), 906 with CRC only (CRC group), 906 with LC only (LC group), and 1,812 healthy subjects using health insurance claim data (2008-2013).
The CRC-LC group had a higher frequency of intensive care unit admission than the CRC group; there were no differences between the 2 groups in terms of early and late postoperative small bowel obstruction and incisional hernia. However, the 30-day, 60-day, and 90-day mortality rates were all significantly higher in the CRC-LC group. The higher Charlson comorbidity index (hazard ratio [HR], 1.127) and the lower socioeconomic status (HR, 0.985) were significant worse predictors of 5-year survival. Patients with underlying LC had a significantly higher HR in both the advanced CRC (HR, 1.858) and nonadvanced CRC (HR, 1.799) subgroups. However, the nonadvanced CRC subgroup showed a lower HR than the LC group (HR, 0.730).
Patients with CRC who had underlying LC had a lower survival rate than did those without LC, although the incidence rates of postoperative complications were not significantly different. The presence of LC was associated with a significantly lower survival rate regardless of CRC presence.
对患有肝硬化（LC）的结直肠癌（CRC）患者进行管理需要全面了解这两种疾病；然而，此类患者的预后和术后结果仍未得到充分研究。我们调查了LC对CRC患者手术和肿瘤学结果的影响，并确定了预后因素。
我们使用医疗保险理赔数据（2008 - 2013年）分析了453例患有CRC和LC的患者（CRC - LC组）、906例仅患有CRC的患者（CRC组）、906例仅患有LC的患者（LC组）以及1812名健康受试者。
CRC - LC组重症监护病房入院频率高于CRC组；两组在术后早期和晚期小肠梗阻及切口疝方面无差异。然而，CRC - LC组的30天、60天和90天死亡率均显著更高。较高的查尔森合并症指数（风险比[HR]，1.127）和较低的社会经济地位（HR，0.985）是5年生存率的显著不良预测因素。基础疾病为LC的患者在晚期CRC（HR，1.858）和非晚期CRC（HR，1.799）亚组中的HR均显著更高。然而，非晚期CRC亚组的HR低于LC组（HR，0.730）。
患有基础疾病LC的CRC患者生存率低于无LC的患者，尽管术后并发症发生率无显著差异。无论是否存在CRC，LC的存在都与显著较低的生存率相关。
