Abstract P5-08-14: Characteristics and risk factors of nonalcoholic fatty liver disease and liver fibrosis in breast cancer survivors
Authors: Kim Hwi Young , Lim Woosung , Moon Byung-In , Lee Hye Ah 
Published: March 2020

Abstract
Background and Aims: Data on the clinical characteristics of nonalcoholic fatty liver disease (NAFLD) in patients with breast cancer are scarce. We aimed to investigate clinical features and risk factors of NAFLD in breast cancer survivors. Method: In this prospective, single-center cohort study, we started screening breast cancer patients since August 2018, who had been followed after appropriate anticancer treatments including surgery, radiotherapy, and chemotherapy in the Cancer Center for Women in our institution. Patients in remission (defined as ‘breast cancer survivors’) with fatty liver on ultrasound at baseline or during follow-up evaluations were referred to the Liver Center in the same institution. Exclusion criteria were i) significant alcohol consumption; ii) other causes of liver diseases, such as viral or autoimmune; iii) evidence of recurrent breast cancer or serious comorbidities (other malignancies, cardiopulmonary diseases, etc.). As of June 2019, a total of 306 patients who gave informed consents were enrolled, and a cross-sectional analysis was conducted. Results: Median age was 53.0 (35-78) years. Body mass index (BMI) was 25.0 kg/m2 (interquartile range [IQR], 23.0-27.7), and waist circumference was 89.0 cm (IQR, 84.2-95.3). Median time period from first visit to consultation was 32.6 months (IQR, 17.9-55.3). For hormonal therapy, 184 patients were taking tamoxifen (60.1%) for 35.8 months (median; IQR, 13.8-53.8) and 75 were on letrozole (24.5%) for 19.2 months (median; IQR, 11.8-43.9), respectively. Metabolic syndrome (MetS) was found in 118 patients (38.6%). Homeostasis model assessment-insulin resistance (HOMA-IR) was 2.19 (median; IQR, 1.46-3.14). Serum AST/ALT were 25 IU/L (IQR, 21-31)/23 IU/L (IQR, 17-34), respectively. Liver stiffness (LS) by transient elastography was 4.2 kPa (median; 2.4-14.6). Controlled attenuation parameter (CAP) was 284.0 dB/m (median; IQR, 242-320). At baseline (i.e., at the time of breast cancer diagnosis), 135 patients had NAFLD (44.1%), whereas 171 patients developed NAFLD during follow-up (‘incident NAFLD’, 55.9%). Patients with incident NAFLD were more commonly on tamoxifen (68.6% vs. 49.6%, P=0.003), had lower baseline BMI (24.7 vs. 26.3 kg/m2, P&lt;0.001), and were less commonly associated with MetS (30.6% vs. 48.1%, P=0.002) compared to those with baseline NAFLD. Patients with baseline NAFLD had lower muscle mass (appendicular skeletal muscle mass [ASM]%, 24.9% vs. 25.8%, P=0.004) and higher fat mass (percentage fat [PF], 36.1% vs. 34.3%, P=0.007). LS was significantly higher in patients with baseline NAFLD than those with incident NAFLD (4.9 kPa vs. 4.4 kPa, P=0.021).In multiple linear regression analyses, risk factors for higher LS were i) HOMA-IR (P&lt;0.001), percentage fat (P&lt;0.001) in overall patients; ii) HOMA-IR (P&lt;0.001), ASM% (P=0.039), percentage fat (P =0.004) in patients with BMI≥25; iii) HOMA-IR (P&lt;0.001) in patients with BMI&lt;25. Conclusion: Breast cancer survivors with baseline or incident NAFLD had distinct characteristics in terms of body composition and metabolic profiles. Lifestyle intervention to ameliorate insulin resistance needs to be underlined to prevent development of NAFLD and/or progression of liver fibrosis in breast cancer survivors.
Citation Format: Hwi Young Kim, Woosung Lim, Byung-In Moon, Hye Ah Lee. Characteristics and risk factors of nonalcoholic fatty liver disease and liver fibrosis in breast cancer survivors [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-08-14.