脂肪性肝病（代谢相关脂肪性肝病、代谢性酒精性肝病和酒精性肝病）中的结直肠癌发病率

Colorectal Cancer Incidence in Steatotic Liver Disease (MASLD, MetALD, and ALD).

作者信息

Kimura Takefumi, Tamaki Nobuharu, Wakabayashi Shun-Ichi, Tanaka Naoki, Umemura Takeji, Izumi Namiki, Loomba Rohit, Kurosaki Masayuki

机构信息

Division of Gastroenterology, Department of Medicine, Shinshu University School of Medicine, Nagano, Japan.

Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan.

出版信息

Clin Gastroenterol Hepatol. 2025 Jan 31. doi: 10.1016/j.cgh.2024.12.018.

DOI:10.1016/j.cgh.2024.12.018

PMID:39892626

Abstract

BACKGROUND AND AIMS

Obesity and alcohol consumption are established risk factors for colorectal cancer (CRC). Recently, a multisociety consensus group has introduced a new classification for steatotic liver disease (SLD), which encompasses metabolic dysfunction-associated steatotic liver disease (MASLD), MASLD and increased alcohol intake (MetALD), and alcohol-associated liver disease (ALD). However, the risk of developing CRC in each of these SLD subgroups is unknown. This nationwide cohort study investigated the risk of CRC in MASLD, MetALD, and ALD patients. The primary endpoint was the occurrence of CRC in each SLD subgroup.

METHODS

We conducted a nationwide, population-based study that included 1,497,813 patients diagnosed with MASLD, MetALD, or ALD, alongside 4,885,536 individuals with no known liver disease as a comparison group. The primary outcome was the incidence of CRC and the risk of CRC was compared between MASLD, MetALD and ALD.

RESULTS

The 5- and 10-year cumulative CRC incidence rates were 0.22% and 0.48% for MASLD, 0.32% and 0.73% for MetALD, and 0.43% and 0.97% for ALD, and 0.15% and 0.31% for the comparison group, respectively. The cumulative incidence of CRC was highest for ALD and significantly greater than that for MetALD, MASLD, and the comparison group (both P < .001). Using the comparison group as the reference and adjusting for age, sex, smoking habit, number of colorectal examinations, diabetes mellitus, dyslipidemia, hypertension, and medication use, the adjusted hazard ratios for CRC were 1.73 (95% CI, 1.59-1.87) for ALD, 1.36 (95% CI, 1.28-1.45) for MetALD, and 1.28 (95% CI, 1.22-1.35) for MASLD.

CONCLUSIONS

The risk of CRC differs significantly among patients with SLD, with the highest incidence observed in those with ALD, followed by MetALD and MASLD.

摘要

背景与目的

肥胖和饮酒是结直肠癌（CRC）公认的危险因素。最近，一个多学会共识小组引入了一种脂肪性肝病（SLD）的新分类，其中包括代谢功能障碍相关脂肪性肝病（MASLD）、MASLD合并饮酒量增加（MetALD）以及酒精性肝病（ALD）。然而，这些SLD亚组中发生CRC的风险尚不清楚。这项全国性队列研究调查了MASLD、MetALD和ALD患者发生CRC的风险。主要终点是每个SLD亚组中CRC的发生情况。

方法

我们进行了一项全国性的基于人群的研究，纳入了1497813例被诊断为MASLD、MetALD或ALD的患者，以及4885536例无已知肝病的个体作为对照组。主要结局是CRC的发病率，并比较了MASLD、MetALD和ALD之间CRC的风险。

结果

MASLD的5年和10年累积CRC发病率分别为0.22%和0.48%，MetALD为0.32%和0.73%，ALD为0.43%和0.97%，对照组分别为0.15%和0.31%。CRC的累积发病率在ALD中最高，且显著高于MetALD、MASLD和对照组（P均<0.001）。以对照组为参照，并对年龄、性别、吸烟习惯、结直肠检查次数、糖尿病、血脂异常、高血压和用药情况进行校正后，ALD发生CRC的校正风险比为1.73（95%CI，1.59-1.87），MetALD为1.36（95%CI，1.28-1.45），MASLD为1.28（95%CI，1.22-1.35）。