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. 2017 Jun 6;12(6):e0178920.
doi: 10.1371/journal.pone.0178920. eCollection 2017.

Oncologic and surgical outcomes in colorectal cancer patients with liver cirrhosis: A propensity-matched study

Eon Chul Han  1 , Seung-Bum Ryoo  2 , Ji Won Park  2 , Jin Wook Yi  2 , Heung-Kwon Oh  3 , Eun Kyung Choe  4 , Heon-Kyun Ha  5 , Byung Kwan Park  6 , Sang Hui Moon  2 , Seung-Yong Jeong  2 , Kyu Joo Park  2
Affiliations

Oncologic and surgical outcomes in colorectal cancer patients with liver cirrhosis: A propensity-matched study

Eon Chul Han et al. PLoS One. .

Abstract

The management of colorectal cancer in patients with liver cirrhosis requires a thorough understanding of both diseases. This study evaluated the effect of liver cirrhosis on oncologic and surgical outcomes and prognostic factors in colorectal cancer patients. Fifty-five consecutive colorectal cancer patients with liver cirrhosis underwent colorectal resection (LC group). Using a prospectively maintained database, these patients were matched 1:4 using propensity scoring with R programming language, package "MatchIt" and "optmatch" by sex, age, cancer location, and tumor stage with 220 patients without liver cirrhosis (non-LC group), resulting in 275 patients. The 5-year overall survival (OS) was significantly worse in the LC group than in the non-LC group (46.7% vs. 76.2% respectively, P < 0.001); however, the 5-year proportion of recurrence free (PRF) rates were similar (73.1% vs. 84.5% respectively, P = 0.094). On multivariate analysis of the LC group, tumor-node-metastasis (TNM) stage ≥III disease, venous invasion, and a model for end-stage liver disease plus serum sodium (MELD-Na) score >10 were prognostic factors for OS. However, the OS was not different between the LC group with MELD-Na score ≤10 and the non-LC group (5-year OS rate, TNM stage ≤II, 85.7 vs 89.5%, p = 0.356; TNM stage ≥III, 41.1 vs 66.2%, p = 0.061). Colorectal cancer patients with liver cirrhosis have poorer OS compared to those without liver cirrhosis; however, the PRF rates are similar. It might be due to the mortality from the liver, and surgical treatment should be actively considered for patients with MELD-Na score <10.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1
Kaplan-Meier plots of proportion of recurrence free between LC group and non-LC group a) overall, b) stage 0 and I, c) stage II, and d) stage III.
Fig 2
Fig 2
Kaplan-Meier plots of overall survival between LC group and non-LC group a) overall, b) stage 0 and I, c) stage II, d) stage III and e) stage IV.
Fig 3
Fig 3. Kaplan-Meier plots of overall survival in LC group according to cancer stage and MELD-Na score.
See this image and copyright information in PMC

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