Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
Department of Internal Medicine, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy.
Metabolism. 2024 Nov;160:156014. doi: 10.1016/j.metabol.2024.156014. Epub 2024 Aug 23.
Metabolic dysfunction-associated steatotic liver disease (MASLD) poses a significant and ever-increasing health and economic burden worldwide. Substantial epidemiological evidence shows that MASLD is a multisystem disease that is associated not only with liver-related complications but is also associated with an increased risk of developing cardiometabolic comorbidities and extrahepatic cancers (principally gastrointestinal [GI] cancers). GI cancers account for a quarter of the global cancer incidence and a third of cancer-related deaths. In this narrative review, we provide an overview of the literature on (a) the epidemiological data on the risk of non-liver GI cancers in MASLD, (b) the putative mechanisms by which MASLD (and factors linked with MASLD) may increase this risk, and (c) the possible pharmacotherapies beneficially affecting both MASLD and extrahepatic GI cancer risk. There are multiple potential pathophysiological mechanisms by which MASLD may increase extrahepatic GI cancer risk. Although further studies are needed, the current evidence supports a possible extrahepatic carcinogenic role for MASLD, regardless of obesity and diabetes status, thus highlighting the potential role of tailoring cancer screening for individuals with MASLD. Although there are conflicting data in the literature, aspirin, statins and metformin appear to exert some chemo-preventive effects against GI cancer.
代谢相关脂肪性肝病（MASLD）给全世界带来了巨大且日益加重的健康和经济负担。大量的流行病学证据表明，MASLD 是一种多系统疾病，不仅与肝脏相关并发症有关，还与发生代谢相关合并症和肝外癌症（主要是胃肠道 [GI] 癌症）的风险增加有关。GI 癌症占全球癌症发病率的四分之一，占癌症相关死亡人数的三分之一。在本综述中，我们概述了有关以下方面的文献：（a）MASLD 中非肝脏 GI 癌症风险的流行病学数据；（b）MASLD（和与 MASLD 相关的因素）可能增加这种风险的假设机制；以及（c）可能对 MASLD 和肝外 GI 癌症风险均有益的药物治疗。MASLD 可能通过多种潜在的病理生理机制增加肝外 GI 癌症的风险。尽管还需要进一步的研究，但目前的证据支持 MASLD 可能具有肝外致癌作用，而与肥胖和糖尿病状态无关，因此突出了针对 MASLD 患者进行癌症筛查的潜在作用。尽管文献中有相互矛盾的数据，但阿司匹林、他汀类药物和二甲双胍似乎对 GI 癌症具有一定的化学预防作用。
