HPB : the official journal of the International Hepato Pancreato Biliary Association · 2026
Association of metabolic dysfunction-associated steatotic liver disease with colorectal cancer incidence and surgical outcomes.
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Elemosho Abdulaziz, Woldesenbet Selamawit, Mirzaeifard Arshum, Yuza Kizuki, Angez Meher, Chatzipanagiotou Odysseas P, Charalampous Charalampos M, Mevawalla Areesh, Alizai Qaidar, Ejaz Rida, Arena Lorenza, Pawlik Timothy M
Аннотация
BACKGROUND: The incidence as well as how metabolic dysfunction-associated steatotic liver disease (MASLD) impacts colorectal cancer (CRC) remains unclear. We sought to define CRC incidence among patients with MASLD and assess the association of MASLD with postoperative outcomes.
METHODS: Adults with incident MASLD/MASH were identified using Epic Cosmos to estimate CRC incidence. CRC patients with versus without pre-existing MASLD were evaluated using propensity score matching and multivariable regression.
RESULTS: Among 2,995,488 patients with MASLD (MASH n = 400,935), 10,588 developed incident CRC (incidence: 109.13 per 100,000 persons per year). CRC incidence was similar in MASH and MASLD without MASH. Patients with MASLD were younger (median age, 67 vs 73 years) and more often had severe obesity (37.7% vs 15.7%), type-2 diabetes (39.9% vs 31.0%), and cirrhosis (10.3% vs 1.6%). After matching, MASLD was independently associated with longer length-of-stay (IRR 1.12, 95% CI 1.09-1.16), 30-day readmission (OR 1.29, 95% CI 1.16-1.44), ICU stay (OR 1.20, 95% CI 1.07-1.34), any 30-day complication (OR 1.24, 95% CI 1.15-1.33), hepatobiliary (OR 1.19, 95% CI 1.06-1.33) and renal complications (OR 1.25, 95% CI 1.05-1.47), yet no difference in mortality.
CONCLUSIONS: CRC arising in the setting of MASLD was associated with greater metabolic and liver-related comorbidity and greater postoperative morbidity, yet long-term survival was similar.
METHODS: Adults with incident MASLD/MASH were identified using Epic Cosmos to estimate CRC incidence. CRC patients with versus without pre-existing MASLD were evaluated using propensity score matching and multivariable regression.
RESULTS: Among 2,995,488 patients with MASLD (MASH n = 400,935), 10,588 developed incident CRC (incidence: 109.13 per 100,000 persons per year). CRC incidence was similar in MASH and MASLD without MASH. Patients with MASLD were younger (median age, 67 vs 73 years) and more often had severe obesity (37.7% vs 15.7%), type-2 diabetes (39.9% vs 31.0%), and cirrhosis (10.3% vs 1.6%). After matching, MASLD was independently associated with longer length-of-stay (IRR 1.12, 95% CI 1.09-1.16), 30-day readmission (OR 1.29, 95% CI 1.16-1.44), ICU stay (OR 1.20, 95% CI 1.07-1.34), any 30-day complication (OR 1.24, 95% CI 1.15-1.33), hepatobiliary (OR 1.19, 95% CI 1.06-1.33) and renal complications (OR 1.25, 95% CI 1.05-1.47), yet no difference in mortality.
CONCLUSIONS: CRC arising in the setting of MASLD was associated with greater metabolic and liver-related comorbidity and greater postoperative morbidity, yet long-term survival was similar.