World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website https://wjon.elmerpub.com

Original Article

Volume 000, Number 000, July 2026, pages 000-000

Exploring the Association Between Colorectal Cancer Metastasis and Metabolic Dysfunction-Associated Steatotic Liver Disease: A Nationwide Analysis

↓ Figure 1. Bar chart comparing outcomes, stratified by the presence of MASLD among colorectal cancer-related hospitalizations. MASLD: metabolic dysfunction-associated steatotic liver disease.

↓ **Table 1.** Patient Demographics Among Colorectal Cancer-Related Hospitalizations, Stratified by the Presence of MASLD
Demographics	Absence of MASLD, n (%)	Presence of MASLD, n (%)	P-value
n (%): number of hospitalizations in each group (percentage of hospitalizations). MASLD: metabolic dysfunction-associated steatotic liver disease.
Age			< 0.001
< 45 years	45,180 (5.8)	1,850 (5.2)
45–64 years	265,930 (34.2)	13,775 (38.7)
> 65 years	467,565 (60.1)	19,970 (56.1)
Sex			0.371
Males	394,740 (50.7)	18,240 (51.2)
Females	383,935 (49.3)	17,355 (48.8)
Race			< 0.001
White	548,785 (70.5)	24,970 (70.2)
African Americans	109,525 (14.1)	4,185 (11.8)
Hispanic	70,200 (9.0)	3,995 (11.2)
Asian/Pacific Islander	25,160 (3.2)	1,225 (3.4)
Native American	3,470 (0.4)	200 (0.6)
Other	21,535 (2.8)	1,020 (2.9)
Primary expected payer			< 0.001
Medicare	457,335 (58.7)	19,640 (55.2)
Medicaid	76,480 (9.8)	3,735 (10.5)
Private	208,835 (26.8)	10,470 (29.4)
Uninsured	17,545 (2.3)	865 (2.4)
Median household income			0.706
Lowest quartile	221,725 (28.5)	10,140 (28.5)
Second quartile	205,890 (26.4)	9,200 (25.9)
Third quartile	186,320 (23.9)	8,600 (24.2)
Highest quartile	164,740 (21.2)	7,655 (21.5)

↓ Table 1. Patient Demographics Among Colorectal Cancer-Related Hospitalizations, Stratified by the Presence of MASLD

Demographics

Absence of MASLD, n (%)

Presence of MASLD, n (%)

P-value

n (%): number of hospitalizations in each group (percentage of hospitalizations). MASLD: metabolic dysfunction-associated steatotic liver disease.

Age

< 0.001

< 45 years

45,180 (5.8)

1,850 (5.2)

45–64 years

265,930 (34.2)

13,775 (38.7)

> 65 years

467,565 (60.1)

19,970 (56.1)

Sex

0.371

Males

394,740 (50.7)

18,240 (51.2)

Females

383,935 (49.3)

17,355 (48.8)

Race

< 0.001

White

548,785 (70.5)

24,970 (70.2)

African Americans

109,525 (14.1)

4,185 (11.8)

Hispanic

70,200 (9.0)

3,995 (11.2)

Asian/Pacific Islander

25,160 (3.2)

1,225 (3.4)

Native American

3,470 (0.4)

200 (0.6)

Other

21,535 (2.8)

1,020 (2.9)

Primary expected payer

< 0.001

Medicare

457,335 (58.7)

19,640 (55.2)

Medicaid

76,480 (9.8)

3,735 (10.5)

Private

208,835 (26.8)

10,470 (29.4)

Uninsured

17,545 (2.3)

865 (2.4)

Median household income

0.706

Lowest quartile

221,725 (28.5)

10,140 (28.5)

Second quartile

205,890 (26.4)

9,200 (25.9)

Third quartile

186,320 (23.9)

8,600 (24.2)

Highest quartile

164,740 (21.2)

7,655 (21.5)

↓ **Table 2.** Comorbidities Among Colorectal Cancer-Related Hospitalizations, Stratified by the Presence of MASLD
Comorbidities	Absence of MASLD, n (%)	Presence of MASLD, n (%)	P-value
n (%): number of hospitalizations in each group (percentage of hospitalizations). MASLD: metabolic dysfunction-associated steatotic liver disease.
Diabetes	203,515 (26.1)	11,340 (31.9)	< 0.001
Hypertension	471,660 (60.6)	21,430 (60.2)	0.539
Chronic pulmonary disease	133,765 (17.2)	6,005 (16.9)	0.504
Coronary artery disease	134,245 (17.2)	5,840 (16.4)	0.077
Chronic kidney disease	112,920 (14.5)	5,440 (15.3)	0.071
Congestive heart failure	105,705 (13.6)	4,640 (13.0)	0.19
Coagulopathy	8,260 (1.1)	1,245 (3.5)	< 0.001
Smoking	274,200 (35.2)	12,445 (34.9)	0.673
Obesity	101,390 (13.0)	6,300 (17.7)	< 0.001
Gastroesophageal reflux disease	161,355 (20.7)	7,985 (22.4)	< 0.001
Obstructive sleep apnea	40,450 (5.2)	2,365 (6.6)	< 0.001
Hyperlipidemia	236,290 (30.4)	10,475 (29.4)	0.112

↓ Table 2. Comorbidities Among Colorectal Cancer-Related Hospitalizations, Stratified by the Presence of MASLD

Comorbidities

Absence of MASLD, n (%)

Presence of MASLD, n (%)

P-value

n (%): number of hospitalizations in each group (percentage of hospitalizations). MASLD: metabolic dysfunction-associated steatotic liver disease.

Diabetes

203,515 (26.1)

11,340 (31.9)

< 0.001

Hypertension

471,660 (60.6)

21,430 (60.2)

0.539

Chronic pulmonary disease

133,765 (17.2)

6,005 (16.9)

0.504

Coronary artery disease

134,245 (17.2)

5,840 (16.4)

0.077

Chronic kidney disease

112,920 (14.5)

5,440 (15.3)

0.071

Congestive heart failure

105,705 (13.6)

4,640 (13.0)

0.19

Coagulopathy

8,260 (1.1)

1,245 (3.5)

< 0.001

Smoking

274,200 (35.2)

12,445 (34.9)

0.673

Obesity

101,390 (13.0)

6,300 (17.7)

< 0.001

Gastroesophageal reflux disease

161,355 (20.7)

7,985 (22.4)

< 0.001

Obstructive sleep apnea

40,450 (5.2)

2,365 (6.6)

< 0.001

Hyperlipidemia

236,290 (30.4)

10,475 (29.4)

0.112

↓ **Table 3.** Outcomes Among Colorectal Cancer-Related Hospitalizations, Stratified by the Presence of MASLD
Outcomes	Absence of MASLD, n (%)	Presence of MASLD, n (%)	P-value
n (%): number of hospitalizations in each group (percentage of hospitalizations). MASLD: metabolic dysfunction-associated steatotic liver disease.
In-hospital mortality	33,483 (4.3)	2,812 (7.9)	< 0.001
Total metastasis	328,600 (42.2)	17,050 (47.9)	< 0.001
Gastrointestinal metastasis	91,535 (11.8)	4,570 (12.8)	0.006
Liver metastasis	185,160 (23.8)	10,845 (30.5)	< 0.001
Non-gastrointestinal metastasis	114,210 (14.7)	5,330 (14.9)	0.487
Lymphoid metastasis	82,790 (10.6)	4,235 (11.9)	< 0.001

↓ Table 3. Outcomes Among Colorectal Cancer-Related Hospitalizations, Stratified by the Presence of MASLD

Outcomes

Absence of MASLD, n (%)

Presence of MASLD, n (%)

P-value

n (%): number of hospitalizations in each group (percentage of hospitalizations). MASLD: metabolic dysfunction-associated steatotic liver disease.

In-hospital mortality

33,483 (4.3)

2,812 (7.9)

< 0.001

Total metastasis

328,600 (42.2)

17,050 (47.9)

< 0.001

Gastrointestinal metastasis

91,535 (11.8)

4,570 (12.8)

0.006

Liver metastasis

185,160 (23.8)

10,845 (30.5)

< 0.001

Non-gastrointestinal metastasis

114,210 (14.7)

5,330 (14.9)

0.487

Lymphoid metastasis

82,790 (10.6)

4,235 (11.9)

< 0.001

↓ **Table 4.** Multivariate Logistic Model Regression Examining the Association Between MASLD and Outcomes Among Colorectal Cancer-Related Hospitalizations
Outcomes	aOR	95% CI	P-value
aOR: adjusted odds ratio; CI: confidence interval; MASLD: metabolic dysfunction-associated steatotic liver disease.
In-hospital mortality	1.85	1.68-2.03	< 0.001
Total metastasis	1.24	1.18-1.30	< 0.001
Gastrointestinal metastasis	1.08	1.00-1.16	0.03
Liver metastasis	1.38	1.31-1.46	< 0.001
Non-gastrointestinal metastasis	1.01	0.93-1.08	0.86
Lymphoid metastasis	1.12	1.04-1.21	0.003

↓ Table 4. Multivariate Logistic Model Regression Examining the Association Between MASLD and Outcomes Among Colorectal Cancer-Related Hospitalizations

Outcomes

aOR

95% CI

P-value

aOR: adjusted odds ratio; CI: confidence interval; MASLD: metabolic dysfunction-associated steatotic liver disease.

In-hospital mortality

1.85

1.68-2.03

< 0.001

Total metastasis

1.24

1.18-1.30

< 0.001

Gastrointestinal metastasis

1.08

1.00-1.16

0.03

Liver metastasis

1.38

1.31-1.46

< 0.001

Non-gastrointestinal metastasis

1.01

0.93-1.08

0.86

Lymphoid metastasis

1.12

1.04-1.21

0.003

↓ **Table 5.** MASLD–Liver Metastasis Interaction by Sex, Age, and Race/Ethnicity in CRC Hospitalizations
Variable	No MASLD	MASLD	Absolute risk difference (%)	Interaction aOR	P-value
Predicted probabilities derived from survey-weighted logistic regression margins. aOR: adjusted odds ratio; CRC: colorectal cancer; MASLD: metabolic dysfunction-associated steatotic liver disease.
Sex
Male	25.2 (24.9–25.5)	33.5 (32.0–35.0)	8.3	Ref
Female	22.3 (22.0–22.7)	26.5 (25.0–27.9)	4.2	0.83 (0.75–0.93)	0.001
Age-groups
18–44	34.0 (33.2–34.9)	44.1 (40.8–47.3)	10.1	Ref	-
45–64	26.8 (26.5–27.2)	34.3 (32.9–35.7)	7.5	1.01 (0.80–1.28)	0.920
65+	20.7 (20.4–21.0)	25.7 (24.4–27.1)	5	0.93 (0.74–1.18)	0.565
Race
White	22.3 (22.1–22.6)	28.8 (27.5–30.1)	6.5	Ref	-
African American	30.3 (29.6–30.9)	38.2 (34.9–41.4)	7.9	1.01 (0.87–1.19)	0.878
Hispanic	24.6 (23.8–25.4)	30.9 (27.8–33.9)	6.3	0.97 (0.83–1.15)	0.752
Asian	22.5 (21.3–23.6)	29.4 (23.7–35.1)	6.9	1.02 (0.76–1.38)	0.875
Native American	22.1 (18.8–25.3)	11.5 (2.3–20.7)	−10.6	0.32 (0.12–0.82)	0.018
Other	25.6 (24.0–27.2)	30.3 (24.3–36.2)	4.7	0.9 (0.66–1.21)	0.475

↓ Table 5. MASLD–Liver Metastasis Interaction by Sex, Age, and Race/Ethnicity in CRC Hospitalizations

Variable

No MASLD

MASLD

Absolute risk difference (%)

Interaction aOR

P-value

Predicted probabilities derived from survey-weighted logistic regression margins. aOR: adjusted odds ratio; CRC: colorectal cancer; MASLD: metabolic dysfunction-associated steatotic liver disease.

Sex

Male

25.2 (24.9–25.5)

33.5 (32.0–35.0)

8.3

Ref

Female

22.3 (22.0–22.7)

26.5 (25.0–27.9)

4.2

0.83 (0.75–0.93)

0.001

Age-groups

18–44

34.0 (33.2–34.9)

44.1 (40.8–47.3)

10.1

Ref

45–64

26.8 (26.5–27.2)

34.3 (32.9–35.7)

7.5

1.01 (0.80–1.28)

0.920

65+

20.7 (20.4–21.0)

25.7 (24.4–27.1)

0.93 (0.74–1.18)

0.565

Race

White

22.3 (22.1–22.6)

28.8 (27.5–30.1)

6.5

Ref

African American

30.3 (29.6–30.9)

38.2 (34.9–41.4)

7.9

1.01 (0.87–1.19)

0.878

Hispanic

24.6 (23.8–25.4)

30.9 (27.8–33.9)

6.3

0.97 (0.83–1.15)

0.752

Asian

22.5 (21.3–23.6)

29.4 (23.7–35.1)

6.9

1.02 (0.76–1.38)

0.875

Native American

22.1 (18.8–25.3)

11.5 (2.3–20.7)

−10.6

0.32 (0.12–0.82)

0.018

Other

25.6 (24.0–27.2)

30.3 (24.3–36.2)

4.7

0.9 (0.66–1.21)

0.475