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.
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).
There were 146 eligible patients. MS was detected in 44.5%, and obesity was in 11 % 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 ≥ 150 mg/dL (OR = 2.19; 95% CI 1.05-4.56; p = 0.035); HDL ≤ 40 mg/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% CI 1.7-19.8; p = 0.004). NAFLD was detected more frequently in tamoxifen-use patients (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 64 months in non-NAFLD; whereas in NAFLD group the median survival was not reached (HR = 1.813, 95% CI 0.93-3.55; p = 0.08).
Waist circumference predicts NAFLD in breast cancer during adjuvant hormonal therapy. NAFLD patients tend to have longer DFS.
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All authors have declared no conflicts of interest.