Effect of Chemotherapy on Fatty Liver Occurrence in Breast and Gastrointestinal Cancer Patients: A Case-Controlled Study

Abstract

Background: Chemotherapy is one of the fundamental treatments for cancer patients, which has significantly improved the survival rate. Alongside its benefits, many side effects are imposed on the patient following chemotherapy. Ones is hepatotoxicity that initially develops as fatty liver and hepatic steatosis, but may progress to liver failure if the risk factors persist. Objectives: We aimed to determine the prevalence of fatty liver in breast and gastrointestinal cancer patients during and after chemotherapy and its risk factors. Methods: This cross-sectional study was performed on 140 patients undergoing chemotherapy for either breast or gastrointestinal cancer who referred to the Oncology Clinic of Birjand University of Medical Sciences in 2016 - 2017. Demographic data regarding the disease and chemotherapy regimens were extracted from the patients’ medical records. Before and after chemotherapy, the patients were evaluated by sonography for fatty liver. Data were imported into SPSS version 19 software and analyzed by chi-square (or Fisher test) and McNemar at the 5% significance level. Results: A total of 152 patients were enrolled in the study, of whom 85 had breast cancer and 67 had gastrointestinal cancer. Most patients were in the age group of 45 - 54 years (48 cases, 31.6%). The mean Body Mass Index (BMI) was 23.17 ± 4.52. The frequency of fatty liver before and after chemotherapy increased from 2% to 46.7% in all patients (P = 0.0001). The frequency of fatty liver after chemotherapy was significantly higher in females than in males (52.4% and 34.7%, respectively, P = 0.04). There was no significant relationship between chemotherapy-induced fatty liver and age (P = 0.9), BMI (P = 0.17), history of diabetes mellitus (P = 0.2), and the presence of metabolic syndrome (P = 0.4). The highest frequency of fatty liver was observed in patients treated with AC-T, FOLFOX, and ECF with 53.5%, 42.9%, and 29.2%, respectively (P = 0.09). Conclusions: The results showed that chemotherapy was associated with a significantly increased risk of fatty liver, which was more in women than in men. However, the occurrence of the fatty liver following chemotherapy could be expected in all scenarios, regardless of diabetes, metabolic syndrome, BMI, and the age of the patients.