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Chronic liver disease linked to higher colorectal cancer risk

Patients with chronic liver diseases have a higher risk for colorectal cancer, even after liver transplantation, compared with the general population, according to the results of a systematic review and meta-analysis.

“Further studies are needed, but strict surveillance for CRC is warranted in this patient population,” investigators from University of Chicago Medicine and Northwestern University Feinberg School of Medicine wrote.

To clarify the risk for CRC in chronic liver diseases relative to the general population, and to determine if liver transplantation affected the risk, researchers searched relevant literature published up to July 2015, and ultimately included 50 studies involving 55,991 patients in their analysis.

The pooled standardized incidence ratio (SIR) for CRC risk was 2.06 (95% CI, 1.46-2.9) for non-transplanted patients with hepatitis and cirrhosis, based on four studies. While the overall CRC risk was about twofold higher in these patients compared with the general population, “the risk appeared to be slightly higher in patients with cirrhosis than with hepatitis suggesting that advanced liver damage may lead to higher risk of CRC,” the investigators wrote.

Further, the pooled SIRs for CRC risk were 6.7 (95% CI, 3.48-12.91) for patients with primary sclerosing cholangitis (PSC; based on three studies); and 2.16 (95% CI, 1.59-2.94) for patients who had undergone liver transplantation (based on 10 studies).

“Meta-regression analysis [showed] the risk of CRC correlated with the proportion of autoimmune related liver diseases in each study suggesting that the risk of post-transplant CRC is higher in those with autoimmune related liver diseases which likely included PSC,” the investigators wrote. “The meta-regression also suggested that there was a 2-fold increased risk of CRC even in the absence of autoimmune related liver diseases.”

The researchers acknowledged that some heterogeneity among the included studies was a limitation of the analysis, and this appeared to be caused by age differences in hepatitis and cirrhosis patients and differences in the proportion of autoimmune related diseases in post-transplant patients, they wrote.

“We propose that patients with chronic hepatitis and cirrhosis require a screening colonoscopy every 5 years as opposed to the 10-year interval in the general population,” they concluded. “Patients undergoing liver transplant should have a colonoscopy before the transplant and subsequently should undergo one at 5-year intervals. The risk of CRC in PSC patients compared with the general population was previously unclear, but the 6-fold increased risk justifies the present recommendation of annual surveillance colonoscopy that should be continued after transplant.” – by Adam Leitenberger

Disclosures: The researchers report no relevant financial disclosures.