Chronic liver disease increases the risk of colorectal cancer

A systematic review and me of Sakuraba and other reports from the University of Chicagota analysis results show that patients with chronic liver disease have a higher risk of colorectal cancer (CRC), even if these patients receive liver transplantation, this risk still exists. (Gastrointestinal Endosc. Online version on December 21, 2016)

Sakuraba said that regardless of the cause of liver disease, patients with chronic liver disease have a higher risk of CRC, and this risk still exists after liver transplantation. Therefore, patients with chronic liver disease should be screened or monitored with greater intensity to reduce the risk of CRC.

Sakuraba et al. Evaluated the risk of CRC in patients with chronic liver disease before and after liver transplantation. The researchers searched for studies on the risk of chronic liver disease and CRC through an electronic database and screened a total of 55 991 patients in 50 studies. According to Sakuraba, in studies that included patients with hepatitis and cirrhosis, the total standardized incidence rate (SIR) was 2.06 (95% CI 1.46 ~ 2.90, P <0.0001), and the heterogeneity was moderate (I2 = 49.2%) This is most likely due to differences in disease subgroups and research intensity.

Three studies have shown that patients with primary sclerosing cholangitis (PSC) have an increased risk of CRC (SIR = 6.70, 95% CI 3.48-12.91; P <0.0001), and moderate heterogeneity (I2 = 36.3%) , Obviously this is due to the difference in research intensity. In those studies that included patients who underwent liver transplantation, the SIR was 2.16 (95% CI 1.59 to 2.94, P <0.0001), and the heterogeneity was moderate (I2 = 56.4%).

In meIn the ta analysis, the proportion of autoimmune-related liver diseases was related to the risk of CRC. Sakuraba said, “Previously it was thought that only PSC patients would have an increased risk of CRC, but our research has shown that the risk of CRC among patients with other chronic liver diseases will also increase. The same increase is very important. “

Patrick Boland from the Roswell Park Cancer Institute in New York is not a member of the study. He pointed out that most of the patients in the study have cirrhosis, PSC or have received liver transplantation. The risk of CRC in PSC patients is particularly obvious. PSC is associated with inflammatory bowel disease, which is a known risk factor for colon cancer, which is also the strongest evidence. However, those who have undergone liver transplantation, especially those with underlying autoimmune diseases, have an increased risk of CRC. Organ transplantation requires the use of immunosuppressive agents, which puts the patient at risk of secondary malignancy for a long time. They have evidence that kidney transplant patients have an increased risk of colon cancer. The data from this study showed that the risk of colon cancer in patients who underwent liver transplantation would be doubled.

Boland said these findings are not new, because inflammation and immunosuppression are risk factors for colon cancer. He believes that colonoscopy may be part of the surgical examination of liver metastases, especially for patients with PSC. He also mentioned that because tumors that occur in different parts of the large intestine have large biological differences, it will be interesting to further study whether the risk of the disease is mainly related to the left or right colon.