Non-alcoholic Fatty Liver Disease Assessed by FIBROSCAN-AST (FAST) Score and Its Association with Colorectal Carcinoma Risk: A Case-Control Study

Background: Non-alcoholic fatty liver disease (NAFLD) is an entity with its evident role in systemic inflammation and tumorigenesis. Notably, the association between colorectal cancer (CRC) and NAFLD identified by the FibroScan-AST (FAST) score allows the assessment of steatosis and fibrosis as risk factors in CRC patients. However, there is a lack of studies to date.

Objective: To determine whether NAFLD, identified by FAST scoring, is associated with an increased risk of colorectal cancer.

Methods: This was a case-control study where the case group involved patients with colorectal cancer before initiating chemotherapy, and the elapsed time between the Vibration-controlled transient elastography exam by Fibroscan and blood collection was less than 6 months, whereas the control group was without any documented chronic liver disease or prior malignancies. The demographic and clinical details of the patients were recorded for each patient. The quantitative values of steatosis and fibrosis were measured according to the controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), both measured using FibroScan and the FAST score calculated. Statistical analyses were performed using SPSS software version 25.

Results: The mean age was 53.7 years in the case group and 50.8 years in the control group. There were 37 males and 16 females in the case group, whereas there were 33 males and 20 females in the control group. About 77.3% of CRC and 71% of the control population had steatosis, defined by CAP ≥238 dB/m (p=0.23). About 68% of the case group and 50% of the control group had fibrosis, defined by LSM ≥7.5 kPa (p=0.02). With rule-in cut off value for FAST score as ≥0.78, 63.4% of the case group and 36.6% of the control group had NASH with a statistically significant p-value of 0.045. Overall, it was found that 61.9% of the CRC patients were positive for NAFLD, whereas 30.1% of the patients found negative for NAFLD. The odds ratio for the association of NASH in CRC patients was 3.12, CI 1.27-7.58, p=0.0015.

Conclusion: It was noted that there was a relationship between NAFLD and CRC, with 61.9% of the colorectal cancer patients shown positive for NAFLD detected by FAST scoring.