Impact of metabolic dysfunction-associated steatotic liver disease on liver metastases and survival in colorectal cancer: a retrospective cohort study

Objective This study investigates the impact of the presence and severity of Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD) on prognosis and metastasis in patients with colorectal cancer (CRC).Methods This retrospective observational study included 242 CRC patients who underwent PET-CT imaging at a tertiary university hospital in Turkey between 2014 and 2019. Hepatosteatosis presence and severity were assessed via non-contrast CT. Demographic data, BMI, comorbidities, smoking history, family history, cancer stage, metastasis status, laboratory results, and FIB-4 scores were recorded. Relationships between hepatosteatosis and survival, metastases, and lab findings were analyzed.Results The mean age was 62.4 ± 11.6 years; 64.5% were female. Hepatosteatosis was present in 125 patients (51.7%), with 90 having mild-to-moderate and 35 having severe hepatosteatosis. BMI was significantly lower in patients without hepatosteatosis (p < 0.002). Rates of liver and extrahepatic metastases at diagnosis were significantly higher in patients with hepatosteatosis compared to those without (p < 0.05). Additionally, stage 4C cancer was more common among patients with hepatosteatosis (p < 0.05).Conclusions This study, the first to explore CRC metastases in MASLD patients, shows a significant association between MASLD and liver metastases. CRC patients with MASLD had higher rates of advanced-stage disease and liver metastases at diagnosis, correlating with shorter survival and poorer prognosis. These findings underscore the importance of early screening and monitoring in CRC patients with MASLD.