The effect of liver steatosis detected by computed tomography (CT) on prognosis and liver metastases in patients with colorectal cancer

Metabolic Dysfunction-associated Steatotic Liver Disease (MASLD) is a chronic liver disease characterized by abnormal fat accumulation in the liver and is associated with metabolic issues such as obesity, diabetes mellitus, hypertension, and hyperlipidemia. Changing lifestyle conditions and dietary habits have increased the prevalence of MASLD. Colorectal Cancers (CRC) is the third most common cancer worldwide and the second leading cause of cancer-related deaths. In our study, we aimed to investigate the impact of the presence or absence of MASLD, as well as its severity if present, on prognosis and liver metastases in patients diagnosed with CRC in our institution, highlighting the importance of early diagnosis and screenings in MASLD patients. A total of 242 patients diagnosed with CRC between 2014 and 2019 at our center were retrospectively selected. The presence and degree of hepatosteatosis were assessed using non-contrast CT images from PET CT scans of these patients. Gender, age, BMI, chronic diseases, smoking status, family history, history of known polyps, stage at diagnosis, metastasis status at diagnosis and during follow-up, laboratory tests, and FIB-4 scores were analyzed. The relationship between the presence or absence of hepatosteatosis, as well as its severity if present, with survival time, metastases, and laboratory findings was investigated. The mean age of the patients included in the study was 62.37±11.6 years, with 64.5% being female. While 117 patients (48.3%) did not have hepatosteatosis, 125 patients (51.7%) had hepatosteatosis, of which 90 were moderate and 35 were severe. The BMI values of patients without hepatosteatosis were significantly lower than those with moderate and severe hepatosteatosis (p<0.002). In a three-group comparison, the prevalence of BMI over 30 was significantly higher in the severe hepatosteatosis group (37.5%) compared to the normal group (10.6%). In a two-group comparison, the proportion of patients with a BMI over 30 was significantly higher in the hepatosteatosis group (27.4%) than in the normal group (10.6%). In the three-group comparison, the frequency of liver metastasis (p=0.013) and metastasis to other organs (p=0.027) at the time of diagnosis showed significant differences among the hepatosteatosis groups. In the two-group classification, the frequency of liver metastasis and metastasis to other organs at diagnosis was significantly higher in patients with hepatosteatosis than in normal patients (p<0.05). In a detailed staging comparison based on the presence of hepatosteatosis, patients classified as stage 4C were significantly more common in the hepatosteatosis group (p<0.05). The rate of stage 4 disease in the hepatosteatosis group was 36.8%, significantly higher than in the normal group (24.8%).The CRP levels of patients with moderate hepatosteatosis were significantly higher than those in the normal group (p=0.021). HDL levels were higher in normal patients (p=0.009), whereas CRP (p=0.006) and uric acid (p=0.038) levels were higher in hepatosteatosis patients. No significant relationship was found between patients' chronic diseases, treatment methods, polyp status, smoking and family history, FIB-4 scores, and other laboratory values. Our study is the first to investigate CRC metastases in MASLD patients and has shown that the presence of MASLD in CRC patients is more frequently associated with liver metastasis. A significantly higher proportion of CRC patients with MASLD were diagnosed at stage 4 compared to those without MASLD. Patients with liver metastasis at the time of CRC diagnosis had significantly lower survival rates. The presence of MASLD is associated with more frequent liver metastases and a worse prognosis in CRC.