Incidence of hepatosteatosis after hormone therapy and association of metabolic disorders with prognosis in breast cancer patients

Introduction: Breast cancer is the most common malignancy and the second cause of death after lung cancer among women. Many clinical trials show that diabetes is strongly associated with the development of different cancer types, as well as obesity. Recent evidences indicate that the risk of breast cancer increased with weight gain. In patients taking hormonal therapy especially tamoxifen, non-alcoholic steatohepatitis is a common adverse event during follow-up. In this study, we aim to investigate the development of fatty liver change after hormonal therapy the effects of metabolic disorders (diabetes, obesity) on disease free survival and overall survival in breast cancer patients. Material and Methods: In this study, 796 patients with breast cancer following between 1998 to 2015 in Dicle University Faculty of Medicine Oncology Department were evaluated for age, gender, menapouse status, body mass index (BMI), time of diagnosis, adjuvant chemotherapy status, disease recurrence and sites of recurrence and metastasis, disease free survival and overall survival, hormonal therapy status and duration of hormonal therapy, presence of diabetes. Patients were randomized in diabetic and non-diabetic, on hormonal therapy and non-hormonal therapy. In both groups, we investigate the development of fatty liver changes by ultrasonographic evaluation before and after therapy. In addition, patients were also randomized according to body mass index in two groups (BMI<30, >30) to search the role of obesity in breast cancer. SPSS 18.0 computer based system were used and p<0,05 value was accepted to be a statistical significance. Results: The patients median age and body mass index were found 48 (18-81) and 27 (16-52). 115 of 796 patients (%14,4) was diabetic. 483 of patients (39,3%) were on hormonal therapy with 335 (69,3%) on tamoxifene, 148 (30,7%) on aromatase inhibitors. Mean hepatosteatosis ratio was studied before and after hormonal therapy (0,47+/-0,683 ; 0,86 +/- 0,91) (p<0.001). In hormonal therapy group receving either tamoxifene and aromatase inhibitors, no statistical significant difference for hepatosteatosis were found. (p : 0,910). In non-diabetic group, mean overall survival was 186.9 months ( 95% CI, 167.2-206.6). In diabetic group, mean overall survival was 111.8 months (95% CI, 97.2-126.5) (p:0,016). Overall survival and disease free survival showed no statistical significant difference between obese and non-obese patients. Conclusion: Hormonal therapy is associated with the development of fatty liver change. In subgroup analysis, no statistically significant difference for hepatosteatosis was found between tamoxifen use and aromatase inhibitors use. We found that diabetes is an independently prognostic factor for breast cancer. Obesity is also an important factor with addittive effect on other prognostic factors but no independent role on disease free survival and overall survival. Keywrods: Breast cancer, diabetes, hormonal therapy, hepatosteatosis, prognosis.