Causes of death in patients diagnosed with liver metastasis: a population-based study

Liver metastasis is a frequent in solid tumors, yet cause-of-death (COD) patterns in this population remain incompletely defined.

We identified patients diagnosed with liver metastasis from 2010 to 2021 in the Surveillance, Epidemiology, and End Results (SEER) 17 database. Deaths were classified as due to the index cancer, a subsequent cancer, or non-cancer causes. The top 25 non-cancer CODs were summarized, and standardized mortality ratios (SMRs) with 95% confidence intervals were calculated to compare non-cancer mortality with that of the U.S. general population overall and across prespecified follow-up intervals.

Among 210,746 patients with liver metastasis, 182,211 died during follow-up. The index cancer accounted for 92.9% of deaths, whereas non-cancer causes and subsequent cancers accounted for 5.4% and 0.4%, respectively. Non-cancer mortality increased over time, rising from 4.84% in 2010 to 6.64% in 2021. Cardiovascular disease was the leading non-cancer COD. Compared with the general population, patients with liver metastasis had an increased risk of non-cancer death overall (SMR, 3.35; 95% CI, 3.28 to 3.41), with the greatest excess risk for septicemia (SMR, 11.3; 95% CI, 10.5 to 12.2). Excess non-cancer mortality was most pronounced within 6 months after diagnosis, when SMRs were highest for septicemia, other infectious diseases, and chronic liver disease/cirrhosis.

In liver metastasis, non-cancer mortality represents an increasingly important component of death. These findings support early multidisciplinary survivorship care that integrates infection prevention and cardiovascular risk management.