Abstract
Purpose
Both hepatic steatosis (HS) and colorectal cancer (CRC) are conditions associated with metabolic syndrome. The liver is the most frequent site of distant metastasis of CRC; however, the impact of HS on the incidence of liver metastasis of CRC is not clearly defined. Then, the correlation with the presence or absence of HS was analyzed.
Methods
A total of 604 CRC patients receiving curative surgical resection who had a preoperative non-enhanced computed tomography (CT) were enrolled. The mean attenuation values (in Hounsfield units) of the liver and spleen were obtained on a plain CT slice, and the patients with liver–spleen attenuation ratio lower than 1.1 were objectively defined as HS. The clinicopathological features of these patients were analyzed, and the association between HS and the clinical features of CRC was examined.
Results
Sixty-three (10.4 %) among the 604 patients were diagnosed as HS. Recurrence-free survival (RFS) and hepatic RFS, but not extrahepatic RFS, were significantly higher in the group with HS (p = 0.04 and p = 0.006). However, this effect was not evident in the group of patients with obesity, defined as body mass index > 25.0. Among the stage I~III cases, HS was significantly associated with lower hepatic, but not extrahepatic, RFS. Moreover, absence of HS was an independent risk factor for hepatic RFS (p = 0.003).
Conclusion
Metastases of CRC are less frequent in fatty liver. Steatosis may be an unfavorable microenvironment for metastatic formation in the liver.
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References
Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011) Global cancer statistics. CA Cancer J Clin 61:69–90
Siegel R, Ward E, Brawley O, Jemal A (2011) Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin 61:212–236
McMillan DC, McArdle CS (2007) Epidemiology of colorectal liver metastases. Surg Oncol 16:3–5
Gassmann P, Haier J (2008) The tumor cell-host organ interface in the early onset of metastatic organ colonisation. Clin Exp Metastasis 25:171–181
Langley RR, Fidler IJ (2011) The seed and soil hypothesis revisited—the role of tumor-stroma interactions in metastasis to different organs. Int J Cancer 128:2527–2535
Uetsuji S, Yamamura M, Yamamichi K, Okuda Y, Takada H, Hioki K (1992) Absence of colorectal cancer metastasis to the cirrhotic liver. Am J Surg 164:176–177
Gervaz P, Pak-art R, Nivatvongs S, Wolff BG, Larson D, Ringel S (2003) Colorectal adenocarcinoma in cirrhotic patients. J Am Coll Surg 196:874–879
Utsunomiya T, Saitsu H, Saku M, Yoshida K, Matsumata T, Shimada M, Sugimachi K (1999) Rare occurrence of colorectal cancer metastasis in livers infected with hepatitis B or C virus. Am J Surg 177:279–281
Qiu HB, Zhang LY, Zeng ZL, Wang ZQ, Luo HY, Keshari RP, Zhou ZW, Xu RH (2011) HBV infection decreases risk of liver metastasis in patients with colorectal cancer: A cohort study. World J Gastroenterol 17:804–808
Marignani M, Angeletti S (2002) Nonalcoholic fatty liver disease. N Engl J Med 347:768–769, author reply 768–769
Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ (2003) Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 348:1625–1638
Center MM, Jemal A, Smith RA, Ward E (2009) Worldwide variations in colorectal cancer. CA Cancer J Clin 59:366–378
Kant P, Hull MA (2011) Excess body weight and obesity—the link with gastrointestinal and hepatobiliary cancer. Nat Rev Gastroenterol Hepatol 8:224–238
Hayashi S, Masuda H, Shigematsu M (1997) Liver metastasis rare in colorectal cancer patients with fatty liver. Hepatogastroenterology 44:1069–1075
Tamura R, Masuda H, Ishii Y, Nemoto N (1999) Relationship between fatty liver and liver metastasis in rats given injection of rat colon cancer cell line. Hepatogastroenterology 46:167–171
Karube H, Masuda H, Hayashi S, Ishii Y, Nemoto N (2000) Fatty liver suppressed the angiogenesis in liver metastatic lesions. Hepatogastroenterology 47:1541–1545
Earl TM, Nicoud IB, Pierce JM, Wright JP, Majoras NE, Rubin JE, Pierre KP, Gorden DL, Chari RS (2009) Silencing of TLR4 decreases liver tumor burden in a murine model of colorectal metastasis and hepatic steatosis. Ann Surg Oncol 16:1043–1050
VanSaun MN, Lee IK, Washington MK, Matrisian L, Gorden DL (2009) High fat diet induced hepatic steatosis establishes a permissive microenvironment for colorectal metastases and promotes primary dysplasia in a murine model. Am J Pathol 175:355–364
Strauss S, Gavish E, Gottlieb P, Katsnelson L (2007) Interobserver and intraobserver variability in the sonographic assessment of fatty liver. AJR Am J Roentgenol 189:W320–W323
Lee SS, Park SH, Kim HJ, Kim SY, Kim MY, Kim DY, Suh DJ, Kim KM, Bae MH, Lee JY et al (2010) Non-invasive assessment of hepatic steatosis: prospective comparison of the accuracy of imaging examinations. J Hepatol 52:579–585
Boyce CJ, Pickhardt PJ, Kim DH, Taylor AJ, Winter TC, Bruce RJ, Lindstrom MJ, Hinshaw JL (2010) Hepatic steatosis (fatty liver disease) in asymptomatic adults identified by unenhanced low-dose CT. AJR Am J Roentgenol 194:623–628
Gaba RC, Knuttinen MG, Brodsky TR, Palestrant S, Omene BO, Owens CA, Bui JT (2012) Hepatic steatosis: correlations of body mass index, CT fat measurements, and liver density with biopsy results. Diagn Interv Radiol 18:282–287
Shores NJ, Link K, Fernandez A, Geisinger KR, Davis M, Nguyen T, Sawyer J, Rudel L (2011) Non-contrasted computed tomography for the accurate measurement of liver steatosis in obese patients. Dig Dis Sci 56:2145–2151
Park YS, Park SH, Lee SS, Kim DY, Shin YM, Lee W, Lee SG, Yu ES (2011) Biopsy-proven nonsteatotic liver in adults: estimation of reference range for difference in attenuation between the liver and the spleen at nonenhanced CT. Radiology 258:760–766
Speliotes EK, Massaro JM, Hoffmann U, Foster MC, Sahani DV, Hirschhorn JN, O’Donnell CJ, Fox CS (2008) Liver fat is reproducibly measured using computed tomography in the Framingham Heart Study. J Gastroenterol Hepatol 23:894–899
Pickhardt PJ, Park SH, Hahn L, Lee SG, Bae KT, Yu ES (2011) Specificity of unenhanced CT for non-invasive diagnosis of hepatic steatosis: implications for the investigation of the natural history of incidental steatosis. Eur Radiol 22:1075–1082
Habermann N, Schon A, Lund EK, Glei M (2010) Fish fatty acids alter markers of apoptosis in colorectal adenoma and adenocarcinoma cell lines but fish consumption has no impact on apoptosis-induction ex vivo. Apoptosis 15:621–630
Sun X, Zhang J, Gupta R, Macgibbon AK, Kuhn-Sherlock B, Krissansen GW (2011) Dairy milk fat augments paclitaxel therapy to suppress tumour metastasis in mice, and protects against the side-effects of chemotherapy. Clin Exp Metastasis 28:675–688
Gutt CN, Brinkmann L, Mehrabi A, Fonouni H, Muller-Stich BP, Vetter G, Stein JM, Schemmer P, Buchler MW (2007) Dietary omega-3-polyunsaturated fatty acids prevent the development of metastases of colon carcinoma in rat liver. Eur J Nutr 46:279–285
Godfrey DI, Hammond KJ, Poulton LD, Smyth MJ, Baxter AG (2000) NKT cells: facts, functions and fallacies. Immunol Today 21:573–583
Ishihara S, Nieda M, Kitayama J, Osada T, Yabe T, Ishikawa Y, Nagawa H, Muto T, Juji T (1999) CD8(+)NKR-P1A (+)T cells preferentially accumulate in human liver. Eur J Immunol 29:2406–2413
Tajiri K, Shimizu Y, Tsuneyama K, Sugiyama T (2009) Role of liver-infiltrating CD3+CD56+ natural killer T cells in the pathogenesis of nonalcoholic fatty liver disease. Eur J Gastroenterol Hepatol 21:673–680
Comba A, Maestri DM, Berra MA, Garcia CP, Das UN, Eynard AR, Pasqualini ME (2010) Effect of omega-3 and omega-9 fatty acid rich oils on lipoxygenases and cyclooxygenases enzymes and on the growth of a mammary adenocarcinoma model. Lipids Health Dis 9:112. doi:10.1186/1476-511X-9-112
Adler M, Taylor S, Okebugwu K, Yee H, Fielding C, Fielding G, Poles M (2011) Intrahepatic natural killer T cell populations are increased in human hepatic steatosis. World J Gastroenterol 17:1725–1731
Kawano T, Nakayama T, Kamada N, Kaneko Y, Harada M, Ogura N, Akutsu Y, Motohashi S, Iizasa T, Endo H et al (1999) Antitumor cytotoxicity mediated by ligand-activated human V alpha24 NKT cells. Cancer Res 59:5102–5105
Dhodapkar KM, Cirignano B, Chamian F, Zagzag D, Miller DC, Finlay JL, Steinman RM (2004) Invariant natural killer T cells are preserved in patients with glioma and exhibit antitumor lytic activity following dendritic cell-mediated expansion. Int J Cancer 109:893–899
Swain MG (2008) Hepatic NKT cells: friend or foe? Clin Sci (Lond) 114:457–466
Rizzo A, Pallone F, Monteleone G, Fantini MC (2011) Intestinal inflammation and colorectal cancer: a double-edged sword? World J Gastroenterol 17:3092–3100
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Murono, K., Kitayama, J., Tsuno, N.H. et al. Hepatic steatosis is associated with lower incidence of liver metastasis from colorectal cancer. Int J Colorectal Dis 28, 1065–1072 (2013). https://doi.org/10.1007/s00384-013-1656-2
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DOI: https://doi.org/10.1007/s00384-013-1656-2