Risk factors and prognostic value of non-alcoholic fatty liver disease (NAFLD) in hormone positive, non-metastatic breast cancer receiving adjuvant hormonal therapy

Abstract

Background: NAFLD is a condition commonly found in breast cancer. This study aims at investigating risk factors, and prognostic impact of NAFLD in hormone-positive breast cancer receiving adjuvant hormonal treatment. Methods: We retrospectively investigated hormone-positive, HER-2-negative, non-metastatic breast cancer patients, diagnosed since January 2010 - December 2018. All patients received hormonal treatment either tamoxifen (Tam), aromatase inhibitor (AI), or tamoxifen followed by aromatase inhibitor (Tam+AI). Clinical data on metabolic profiles (BMI, waist circumference, cholesterol, triglyceride, LDL, HDL, diabetes, or metabolic syndrome [MS]) were collected. Fatty liver displayed by USG. NAFLD diagnosed during hormonal treatment was analyzed based on metabolic risk factors, type of hormonal treatment, and disease-free survival (DFS). Results: There were 146 eligible patients. MS was detected in 44.5%, and obesity was in II % patients. Tam were used in 44.5% patients, whereas Tam+AI in 21.2%, and AI in 34.2%. NAFLD was diagnosed in 31.5% patients. There were significant association between obesity (OR = 3.20; 95%CI 1.12- 9.31; p = 0.024); waist circumference > 80 cm (OR = 7.30;95%CI 2.43-21.93; p = 0.000); triglyceride > 150mg/dL (OR = 2.19; 95% CI 1.05-4.56; p =0.035); HDL < 40mg/dl (OR = 2.58; 95% CI 1.06- 6.32; p =0.03); MS (OR = 2.65; 95% CI 1.29-5.43; p =0.007) with arising of NAFLD. Multivariate analysis showed that waist circumference was the strongest predictor to NAFLD (HR 5.92, 95% CI1.7-19.8; p=0.004). NAFLD was detected morefrequently in tamoxifen-usepatients (36.8%) compare to AI (16.6%) (OR=1.94; 95% CI=0.90-4.19; p < 0.08). Interestingly, there were less progression events in patients with NAFLD compared to non-NAFLD (23.9% vs. 40%;OR=0.47, 95%CI 0.2-1.04; p=0.058). Median survival time was 64months in non-NAFLD;whereasin NAFLD group the median survival was not reached (HR = 1.813, 95% CI 0.93-3.55; p =0.08). Conclusions: Waist circumference predicts NAFLD in breast cancer during adjuvant hormonal therapy. NAFLD patients tend to have longer DFS.