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KMID : 1134120210240050417
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Journal of Breast Cancer
2021 Volume.24 No. 5 p.417 ~ p.427
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Fatty Liver in Hormone Receptor-Positive Breast Cancer and Its Impact on Patient's Survival
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Taroeno-Hariadi Kartika Widayati
Putra Yasjudan Rastrama
Choridah Lina
Widodo Irianiwati
Hardianti Mardiah Suci
Aryandono Teguh
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Abstract
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Purpose: Long-term estrogen inhibition may cause fatty liver disease (non-alcoholic fatty liver disease; NAFLD) among other adverse conditions such as osteoporosis, climacteric symptoms, thromboembolism, dyslipidemia, and metabolic syndrome. The prevalence of NAFLD among breast cancer patients ranges from 2.3%?45.2%. This study aimed to determine the risk factors for newly developed NAFLD among breast cancer patients after hormonal treatment and whether it influences survival outcomes.
Methods: This retrospective study investigated hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative (HR+/HER2?), nonmetastatic breast cancer patients diagnosed between January 2010 and December 2018. All patients received adjuvant hormonal treatment for at least 6 months. Clinical data on metabolic profile indicators such as body mass index (BMI), waist circumference, serum cholesterol, triglycerides, low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), diabetes, and presence of metabolic syndrome (MetS) were collected. In total, 160 eligible patients with complete covariate data and survival follow-up were included.
Results: NAFLD was diagnosed in 35% of patients. There were significant associations of being overweight (BMI ≥ 25 kg/m2), waist circumference > 80 cm, triglycerides ≥ 150 mg/dL, HDL-C ≤ 50 mg/dL, LDL-C < 150 mg/dL, and presence of MetS with the development of NAFLD. However, unlike other factors, MetS and HDL-C were not independently associated with NAFLD. Patients with breast cancer who developed NAFLD had longer disease-free survival (DFS). The median DFS was not reached in the NAFLD group, whereas it was 59.3 (45.6?73.0) months in the non-NAFLD group. No worsening of overall survival was observed in patients with breast cancer and NAFLD.
Conclusion: The development of NAFLD during treatment in patients with HR+/HER2? breast cancer was associated with several independent risk factors: being overweight, waist circumference, triglycerides, and LDL-C. Interestingly, breast cancer patients with NAFLD during treatment had longer DFS than those without NAFLD.
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KEYWORD
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Aromatase inhibitors, Breast neoplasms, Fatty liver, Non-alcoholic fatty liver disease, Tamoxifen
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