Background
Metabolic syndrome is associated with various malignancies, including breast cancer. Non-alcoholic fatty liver disease (NAFLD) is a hepatic manifestation of metabolic syndrome. NAFLD is frequently observed during chemotherapy, but its clinical implication is unclear. The purpose of this study is to evaluate the prognostic value of NAFLD in patients with stage II/III breast cancer who received neoadjuvant chemotherapy (NAC Tx).
Methods
The patients with clinical stage II/III breast cancer who received NAC Tx with docetaxel and doxorubicin were enrolled. Treatment sequences were: 3 cycles of NAC Tx → surgery → 3 cycles of adjuvant chemotherapy (AC Tx), or 6 cycles of NAC Tx → surgery, allowing AC Tx at the physician's discretion. NAFLD was determined by ultrasonography (radiologists' decision), non-constrast computed tomography [CT] (the attenuation of liver is less than that of spleen or <49 hounsfield unit [HU]) or contrast CT (the difference between liver and spleen attenuation < -18.5 HU). The presence of NAFLD was evaluated 3 times, at diagnosis, after NAC Tx and after the completion of AC Tx. Improvement of NAFLD was defined as the disappearance of NAFLD after NAC Tx.
Results
Between 2002 and 2008, 269 patients were enrolled. The median age was 45 (range 18-69), and 51.7% and 28.6% were with hormone receptor and HER2 positive tumors, respectively. The median number of NAC Tx was 3 cycles (range 1-6). NAFLD was observed in 33 (12.4%) patients at diagnosis, 52 (19.3%) after NAC Tx and 71 (26.4%) at the completion of AC Tx. The patients with NAFLD at diagnosis showed shorter overall survival than those without NAFLD (HR=2.688, 95% CI 1.259-5.747, P=0.011). The improvement of NAFLD during NAC Tx was observed in 28 (10.4%, group A) and persistence of NAFLD observed in 24 (8.9%, group B). Group A showed better prognosis in both PFS (HR 0.125, 95 % CI 0.016-0.962) and OS (no event), whereas group B showed worse PFS (HR 2.329, 95% CI 1.280-4.237) and OS (HR 3.721, 95% CI 1.727-8.015) compared to the patients without NAFLD at diagnosis.
Conclusions
NAFLD at diagnosis was a poor prognostic marker of OS in patients who received NAC Tx. Improvement of NAFLD during NAC TX was associated with good prognosis in terms of PFS and OS.
Citation Format: Yang Y, Lee K-H, Kim T-Y, Han S-W, Oh D-Y, Kim T-Y, Han W, Moon H-G, Park IA, Noh D-Y, Im S-A. Prognostic value of non-alcoholic fatty liver disease in stage II/III breast cancer patients who received neoadjuvant chemotherapy. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-10-11.
