Analysis of risk factors for colorectal cancer with liver metastasis based on the SEER database: A propensity score matching study

doi:10.3969/j.issn.1004-583X.2025.09.007

Abstract

Abstract:

Objective To analyze independent risk factors for liver metastasis in colorectal cancer based on the SEER database. Methods A total of 60, 136 colorectal cancer patients from the SEER database between 2010 and 2019 were included, among whom 5, 072 developed liver metastases. Propensity score matching(PSM)(1∶1) was used to balance the baseline clinical characteristics between the liver metastasis and non-metastasis groups, resulting in a matched cohort of 9, 716 patients with 4, 858 cases in each group. Univariate logistic regression analysis was applied both before and after matching the identified risk factors for liver metastasis. Results Before matching, univariate logistic regression analysis identified 12 factors(age, sex, race, T stage, N stage, radiotherapy, chemotherapy, brain metastasis, bone metastasis, lung metastasis, distant lymph node metastasis, and other rare site metastases) as independent risk factors for liver metastasis. After matching, chemotherapy and metastasis to other rare sites were identified as protective factors against liver metastasis in colorectal cancer(OR<1), while bone and lung metastases were independent risk factors. Additionally, among primary tumor sites, the highest incidence of liver metastasis was observed in the transverse colon(9.86%), followed by the rectosigmoid colon(8.91%). Conclusion The importance of chemotherapy as a protective factor against liver metastasis in colorectal cancer should be highlighted. For colorectal cancer patients who have already developed bone or lung metastases, enhanced monitoring and intervention for liver metastasis are essential to develop personalized treatment strategies and improve the prognosis.

Key words: colorectal neoplasms, liver metastasis, propensity score matching, risk factors

CLC Number:

R735.34

Wei Tingting, Pan Zhengyan, Feng Xianyan, Long Yaxiu. Analysis of risk factors for colorectal cancer with liver metastasis based on the SEER database: A propensity score matching study[J]. Clinical Focus, 2025, 40(9): 816-820.

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URL: https://www.lchc.cn/EN/10.3969/j.issn.1004-583X.2025.09.007

https://www.lchc.cn/EN/Y2025/V40/I9/816

Figures/Tables 3

Fig.1 Case screening flow chart

Tab.1 Demographic and clinical characteristics of patients with colorectal cancer(n, %)

变量	PSM前				PSM后
变量	非肝转移组 ( $n$ =55 064)	肝转移组 ( $n$ =5 072)	χ²值	$P$ 值	非肝转移组 ( $n$ =4 858)	肝转移组 ( $n$ =4 858)	χ²值	$P$ 值
年龄
<50岁 ≥50岁	7 155(12.99) 47 909(87.01)	992(19.56) 4 080(80.44)	170.87	<0.01	1 006(20.71) 3 852(79.29)	952(19.60) 3 906(80.40)	1.86	0.172
性别
女男	25 929(47.09) 29 135(52.91)	2 174(42.86) 2 898(57.14)	33.32	<0.01	2 106(43.35) 2 752(56.65)	2 078(42.77) 2 780(57.23)	0.33	0.566
种族
白人	6 164(11.19)	728(14.35)			695(14.31)	699(14.39)
黑人	43 072(78.22)	3 802(74.96)	46.82	<0.01	3 640(74.93)	3 650(75.13)	0.20	0.654
其他	5 828(10.54)	542(10.65)			523(10.77)	509(10.44)
T分期
T1/2 T3/4	17 241(31.31) 37 823(68.69)	267(5.26) 4 805(94.74)	1526.70	<0.01	266(5.48) 4 592(94.52)	266(5.48) 4 592(94.52)	0.00	1.000
N分期
N0 N1/2	31 796(57.74) 23 268(42.26)	832(16.40) 4 240(83.60)	3197.95	<0.01	807(16.61) 4 051(83.39)	832(17.13) 4 026(82.87)	0.46	0.498
手术
无	98(0.18)	33(0.65)			32(0.66)	27(0.56)
肿瘤切除术	176(0.32)	7(0.14)	52.70	<0.01	4(0.08)	7(0.14)	1.24	0.537
根治术	54 790(99.50)	5 032(99.21)			4 822(99.26)	4 824(99.30)
放疗
无有	47 330(85.95) 7 734(14.05)	4 490(88.53) 582(11.47)	25.76	<0.01	4 269(87.88) 589(12.12)	4 278(88.06) 580(11.94)	0.08	0.779
化疗
无有	31 367(56.96) 23 697(43.04)	1 083(21.35) 3 989(78.65)	2 370.84	<0.01	963(19.82) 3 895(80.18)	1 065(21.92) 3 793(78.08)	6.48	0.011
脑转移
无有	55 036(99.95) 28(0.05)	5 048(99.53) 24(0.47)	91.06	<0.01	4 845(99.73) 13(0.27)	4 840(99.63) 18(0.37)	0.81	0.368
骨转移
无有	54 957(99.81) 107(0.19)	4 945(97.50) 127(2.50)	639.16	<0.01	4 783(98.46) 75(1.54)	4 755(97.88) 103(2.12)	4.49	0.034
肺转移
无有	54 520(99.01) 544(0.99)	4 327(85.31) 745(14.69)	4156.04	<0.01	4 388(90.33) 470(9.67)	4 316(88.84) 542(11.16)	5.72	0.017
远处淋巴结转移
无有	54 603(99.16) 461(0.84)	4 652(91.72) 420(8.28)	1 782.55	<0.01	4 544(93.54) 314(6.46)	4 508(92.80) 350(7.20)	2.10	0.148
其他少见部位转移
无有	53 355(96.90) 1 709(3.10)	4 321(85.19) 751(14.81)	1 621.27	<0.01	4 102(84.44) 756(15.56)	4 184(86.13) 674(13.87)	5.51	0.019
部位
阑尾及盲肠	11 303(20.53)	1 058(20.86)			1 011(20.81)	1 017(20.93)
升结肠	8 970(16.29)	659(12.99)	46.69	<0.01	616(12.68)	625(12.87)	0.78	0.942
直肠及乙状结肠	24 466(44.43)	2 392(47.16)			2 296(47.26)	2 279(46.91)
横结肠	7 733(14.04)	684(13.49)			655(13.48)	672(13.83)
降结肠	2 592(4.71)	279(5.50)			280(5.76)	265(5.45)

Tab.1 Demographic and clinical characteristics of patients with colorectal cancer(n, %)

变量	PSM前				PSM后
变量	非肝转移组 ( $n$ =55 064)	肝转移组 ( $n$ =5 072)	χ²值	$P$ 值	非肝转移组 ( $n$ =4 858)	肝转移组 ( $n$ =4 858)	χ²值	$P$ 值
年龄
<50岁 ≥50岁	7 155(12.99) 47 909(87.01)	992(19.56) 4 080(80.44)	170.87	<0.01	1 006(20.71) 3 852(79.29)	952(19.60) 3 906(80.40)	1.86	0.172
性别
女男	25 929(47.09) 29 135(52.91)	2 174(42.86) 2 898(57.14)	33.32	<0.01	2 106(43.35) 2 752(56.65)	2 078(42.77) 2 780(57.23)	0.33	0.566
种族
白人	6 164(11.19)	728(14.35)			695(14.31)	699(14.39)
黑人	43 072(78.22)	3 802(74.96)	46.82	<0.01	3 640(74.93)	3 650(75.13)	0.20	0.654
其他	5 828(10.54)	542(10.65)			523(10.77)	509(10.44)
T分期
T1/2 T3/4	17 241(31.31) 37 823(68.69)	267(5.26) 4 805(94.74)	1526.70	<0.01	266(5.48) 4 592(94.52)	266(5.48) 4 592(94.52)	0.00	1.000
N分期
N0 N1/2	31 796(57.74) 23 268(42.26)	832(16.40) 4 240(83.60)	3197.95	<0.01	807(16.61) 4 051(83.39)	832(17.13) 4 026(82.87)	0.46	0.498
手术
无	98(0.18)	33(0.65)			32(0.66)	27(0.56)
肿瘤切除术	176(0.32)	7(0.14)	52.70	<0.01	4(0.08)	7(0.14)	1.24	0.537
根治术	54 790(99.50)	5 032(99.21)			4 822(99.26)	4 824(99.30)
放疗
无有	47 330(85.95) 7 734(14.05)	4 490(88.53) 582(11.47)	25.76	<0.01	4 269(87.88) 589(12.12)	4 278(88.06) 580(11.94)	0.08	0.779
化疗
无有	31 367(56.96) 23 697(43.04)	1 083(21.35) 3 989(78.65)	2 370.84	<0.01	963(19.82) 3 895(80.18)	1 065(21.92) 3 793(78.08)	6.48	0.011
脑转移
无有	55 036(99.95) 28(0.05)	5 048(99.53) 24(0.47)	91.06	<0.01	4 845(99.73) 13(0.27)	4 840(99.63) 18(0.37)	0.81	0.368
骨转移
无有	54 957(99.81) 107(0.19)	4 945(97.50) 127(2.50)	639.16	<0.01	4 783(98.46) 75(1.54)	4 755(97.88) 103(2.12)	4.49	0.034
肺转移
无有	54 520(99.01) 544(0.99)	4 327(85.31) 745(14.69)	4156.04	<0.01	4 388(90.33) 470(9.67)	4 316(88.84) 542(11.16)	5.72	0.017
远处淋巴结转移
无有	54 603(99.16) 461(0.84)	4 652(91.72) 420(8.28)	1 782.55	<0.01	4 544(93.54) 314(6.46)	4 508(92.80) 350(7.20)	2.10	0.148
其他少见部位转移
无有	53 355(96.90) 1 709(3.10)	4 321(85.19) 751(14.81)	1 621.27	<0.01	4 102(84.44) 756(15.56)	4 184(86.13) 674(13.87)	5.51	0.019
部位
阑尾及盲肠	11 303(20.53)	1 058(20.86)			1 011(20.81)	1 017(20.93)
升结肠	8 970(16.29)	659(12.99)	46.69	<0.01	616(12.68)	625(12.87)	0.78	0.942
直肠及乙状结肠	24 466(44.43)	2 392(47.16)			2 296(47.26)	2 279(46.91)
横结肠	7 733(14.04)	684(13.49)			655(13.48)	672(13.83)
降结肠	2 592(4.71)	279(5.50)			280(5.76)	265(5.45)

Tab.2 Logistic regression analysis of risk factors for liver metastasis in colorectal cancer

变量	PSM前		PSM后
变量	$P$ 值	$O R$ (95% $C I$ )	$P$ 值	$O R$ (95% $C I$ )
年龄(≥50岁vs <50岁)	<0.01	0.61(0.57~0.66)	0.172	1.07(0.97~1.18)
性别(男性vs女性)	<0.01	1.19(1.12~1.26)	0.566	1.02(0.94~1.11)
种族
黑人vs白人	<0.01	0.75(0.69~0.81)	0.959	0.997(0.889~1.118)
其他vs白人	<0.01	0.79(0.70~0.89)	0.689	0.968(0.824~1.137)
T3/4 vs T1/2	<0.01	8.20(7.24~9.29)	1.000	1.00(0.84~1.19)
N1/N0	<0.01	6.96(6.45~7.52)	0.498	0.96(0.87~1.07)
手术
肿瘤切除术vs无手术	<0.01	0.12(0.05~0.28)	0.283	2.07(0.55~7.85)
扩大切除术vs无手术	<0.01	0.27(0.18~0.41)	0.516	1.19(0.71~1.98)
放疗	<0.01	0.79(0.73~0.87)	0.779	0.98(0.87~1.11)
化疗	<0.01	4.88(4.55~5.23)	0.011	0.88(0.80~0.97)
脑转移	<0.01	9.35(5.41~16.13)	0.370	1.39(0.68~2.83)
骨转移	<0.01	13.19(10.18~17.09)	0.035	1.38(1.02~1.87)
肺转移	<0.01	17.26(15.38~19.35)	0.017	1.17(1.03~1.34)
远处淋巴结转移	<0.01	10.69(9.34~12.25)	0.148	1.12(0.96~1.32)
其他少见部位转移	<0.01	5.43(4.95~5.94)	0.019	0.87(0.78~0.98)
位置
升结肠vs阑尾及盲肠	<0.01	0.78(0.71~0.87)	0.905	1.01(0.88~1.16)
直、乙状结肠vs阑尾及盲肠	0.260	1.04(0.97~1.13)	0.802	0.99(0.89~1.10)
横结肠vs阑尾及盲肠	0.269	0.94(0.85~1.04)	0.780	1.02(0.89~1.17)
降结肠vs阑尾及盲肠	0.048	1.15(1.01~1.32)	0.528	0.94(0.78~1.14)

Tab.2 Logistic regression analysis of risk factors for liver metastasis in colorectal cancer

变量	PSM前		PSM后
变量	$P$ 值	$O R$ (95% $C I$ )	$P$ 值	$O R$ (95% $C I$ )
年龄(≥50岁vs <50岁)	<0.01	0.61(0.57~0.66)	0.172	1.07(0.97~1.18)
性别(男性vs女性)	<0.01	1.19(1.12~1.26)	0.566	1.02(0.94~1.11)
种族
黑人vs白人	<0.01	0.75(0.69~0.81)	0.959	0.997(0.889~1.118)
其他vs白人	<0.01	0.79(0.70~0.89)	0.689	0.968(0.824~1.137)
T3/4 vs T1/2	<0.01	8.20(7.24~9.29)	1.000	1.00(0.84~1.19)
N1/N0	<0.01	6.96(6.45~7.52)	0.498	0.96(0.87~1.07)
手术
肿瘤切除术vs无手术	<0.01	0.12(0.05~0.28)	0.283	2.07(0.55~7.85)
扩大切除术vs无手术	<0.01	0.27(0.18~0.41)	0.516	1.19(0.71~1.98)
放疗	<0.01	0.79(0.73~0.87)	0.779	0.98(0.87~1.11)
化疗	<0.01	4.88(4.55~5.23)	0.011	0.88(0.80~0.97)
脑转移	<0.01	9.35(5.41~16.13)	0.370	1.39(0.68~2.83)
骨转移	<0.01	13.19(10.18~17.09)	0.035	1.38(1.02~1.87)
肺转移	<0.01	17.26(15.38~19.35)	0.017	1.17(1.03~1.34)
远处淋巴结转移	<0.01	10.69(9.34~12.25)	0.148	1.12(0.96~1.32)
其他少见部位转移	<0.01	5.43(4.95~5.94)	0.019	0.87(0.78~0.98)
位置
升结肠vs阑尾及盲肠	<0.01	0.78(0.71~0.87)	0.905	1.01(0.88~1.16)
直、乙状结肠vs阑尾及盲肠	0.260	1.04(0.97~1.13)	0.802	0.99(0.89~1.10)
横结肠vs阑尾及盲肠	0.269	0.94(0.85~1.04)	0.780	1.02(0.89~1.17)
降结肠vs阑尾及盲肠	0.048	1.15(1.01~1.32)	0.528	0.94(0.78~1.14)

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