Clinical Study On The Status Of Liver Injury During Chemotherapy In Breast Cancer Patients

Background and purpose:Breast cancer is the most common malignant tumor in females in the world and the highest incidence of malignant tumor in females in China.Most breast cancer patients receive chemotherapy after operation,almost all drugs for chemotherapy cause hepatotoxicity and may leads to liver injury.Hepatotoxicity is affected by many factors including hepatitis virus infection.While there are a large number of patients with previous hepatitis B infection in breast cancer patients in our country.The purpose of this paper is to study the status of drug induced liver injury in patients with breast cancer during chemotherapy,and to explore the causes and the relationship among them.Methods:From Sep.2014 to Apr 2016,1024 patients initially diagnosed with breast cancer in the First Affiliated Hospital of Chongqing Medical University(Chongqing Breast Cancer Center)were studied and among them,there were 897 patients who received chemotherapy with complete data.The incidence of liver injury and the influence of hepatitis B markers on drug-induced liver injury in patients with breast cancer during chemotherapy were statistically analyzed according to the information of chemotherapy regimen,course of chemotherapy,and liver function before and after chemotherapy and follow-up statistics.Results:1.Among the 897 patients,239 cases(26.2%) were diagnosed with abnormal liver function 16 cases(1.7%) had to stop medication and 4 patients(0.4%)suffered grade 3-4 hepatitis(3 HbsAg positive).2.Among the 897 patients,81 patients(9.0%) were HbsAg positive,of which 28 cases(34.6%) suffered abnormal liver function,4 cases(4.9%) suffered hepatitis B virus reactivation.There were 216(24.1%) cases with negative HbsAg positive HBcAb and HbeAb,among which 62 cases(28%) suffered abnormal liver function.There were 192 cases(21.4%) with negative hepatitis B markers,of which 47 cases had liver injury(24.4%).There were 268(29.8%) cases with negative hepatitis B markers or only positive surface antibody,of which 67 cases(25%) suffered abnormal liver function(25%),3.Drug withdrawal happened in 16 patients,5(31.3%) of them were HbsAg positive,3 of which were found to have hepatitis B virus reactivation,and 1 of them suffered interrupted chemotherapy;There were 7(43.8%) cases with positive HBcAb and negative HbsAg,and 4(25%) cases with negative HBV marker or only positive surface antibody.4.There were 4 patients who suffered grade 3-4 hepatitis(3 HbsAg positive and 1 HBcAb positive),the pattern of DILI of these 4 patients with poor prognosis were classified with 3 hepatocellular and 1mixed);5.After removing all the other possible factors affecting liver function,the patterns of DILI of HbsAg positive patients(hepatocellular,37.5%,mixed 53.5% cholestatic 8.9%) were significantly different from those of patients with negative hepatitis B markers(hepatocellular,11.7%,mixed 44.1% cholestatic 44.1%,p=0.02),and patients with negative hepatitis B markers or only positive surface antibody(hepatocellular,8.9%,mixed 53.5%cholestatic 37.5%,p=0.018),respectively.Conclusions:1.Chinese breast cancer patients,especially with positive HbsAg,have a high incidence of abnormal liver function during chemotherapy.2.A high proportion(9.0%) of Chinese breast cancer women receiving chemotherapy have hepatitis B infection,and they are more likely to suffer severe liver injury and hepatitis B virus reactivation,which need close monitoring and early intervention.3.Compared with HBV markers negative patients,the DILI classifications of HbsAg positive patients who receive chemotherapy include more hepatocellular injuries and mixed injuries which are associated with poor prognosis and much attention should be paid to them.