Metabolic dysfunction-associated steatotic liver disease increases the incidence of metachronous liver metastases from TNM stage 0-II colorectal cancer.

Background and aims: Metachronous colorectal liver metastases (CRLM) had been the main cause of death in most colorectal cancer (CRC) patients after curative surgery. However, the clinical impact of the pre-existing metabolic dysfunction-associated steatotic liver disease (MASLD) on metachronous CRLM remains unclear, the present study aims to clarify this issue.

Methods: This study retrospectively enrolled in 2155 CRC patients who underwent curative surgery at the Sixth Affiliated Hospital of Sun Yat-sen University from 2017 to 2018, including 300 cases with MASLD and 1855 cases of Control group. Cox regression and Kaplan-Meier curves were constructed to evaluate the influencing factors and cumulative incidence of recurrence (CIR) of metachronous CRLM.

Results: The pre-existing MASLD was an independent risk factor for metachronous CRLM in TNM stage 0-II CRC patients (HR, 2.696; 95% CI 1.553-4.681; p < 0.001), and this association persisted for both early (HR, 2.309; 95% CI 1.008-5.291; p = 0.048) and late (HR, 2.791; 95% CI 1.321-5.894; p = 0.007) metachronous CRLM. However, pre-existing MASLD was not independently associated with metachronous CRLM in TNM stage III CRC patients. In TNM stage 0-II CRC patients, the 5-year hepatic CIR rate in the MASLD group was significantly higher than that in the Control group (9.3% vs. 4.0%, p < 0.001). MASLD had no significant impact on metachronous extrahepatic metastases for TNM stage 0-II and stage III CRC patients.

Conclusions: The pre-existing MASLD is an independent and important risk factor predicting hepatic recurrence for CRC patients of TNM stage 0-II after curative surgery.