J Cancer 2020; 11(15):4597-4604. doi:10.7150/jca.44872 This issue

Research Paper

The impact of pre-existed and SERM-induced non-alcoholic fatty liver disease on breast cancer survival: a meta-analysis

Changjun Wang1*, Yidong Zhou1*, Wei Huang1*, Ziyuan Chen1, Hanjiang Zhu2, Feng Mao1, Yan Lin1, Xiaohui Zhang1, Songjie Shen1, Ying Zhong1, Xin Huang1, Chang Chen1, Qiang Sun1✉

1. Department of Breast Surgery, Peking Union Medical College Hospital, Beijing, China
2. Department of Dermatology, 90 Medical Center Way, Surge 110, University of California, San Francisco, CA 94143-0989, United States
*These three authors contributed equally to this article

This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions.
Wang C, Zhou Y, Huang W, Chen Z, Zhu H, Mao F, Lin Y, Zhang X, Shen S, Zhong Y, Huang X, Chen C, Sun Q. The impact of pre-existed and SERM-induced non-alcoholic fatty liver disease on breast cancer survival: a meta-analysis. J Cancer 2020; 11(15):4597-4604. doi:10.7150/jca.44872. Available from https://www.jcancer.org/v11p4597.htm

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Background: Non-alcoholic fatty liver disease (NAFLD) is a common disorder and a frequent side effect of endocrine therapy (ET) for breast cancer treatment. This was the first meta-analysis to investigate the impact of NAFLD on breast cancer survival.

Material and Methods: We searched Pubmed, Embase and Cochrane Central Register of Controlled Trials database for relevant studies that investigated the correlation between NAFLD and breast cancer survival. Fixed- and random-effect meta-analyses were conducted according to the heterogeneity of enrolled studies. Subgroup analyses were performed based on whether NAFLD was induced by ET administration

Results: Eight cohorts from six studies including 3684 breast cancer patients were enrolled. NAFLD was significantly associated with advanced age (p < 0.001), obesity (p < 0.001), lymph node metastases (p = 0.003) and hormone receptor positivity (p < 0.001). NAFLD had no significant impact on disease free survival (DFS) [hazard ratio (HR) 1.07, 95% confidence interval (CI) = 0.64-1.77, p = 0.81] and overall survival (OS) (HR 1.29, 95% CI = 0.68-2.44, p = 0.44). In subgroup analyses, ET-associated NAFLD showed no significant impact on DFS and OS. Nonetheless, non-ET-associated NAFLD had a strong prognostic correlation with poor OS (HR 1.92, 95% CI = 1.09-3.41, p = 0.02).

Conclusion: NAFLD had no significant impact on breast cancer survival. However, non-ET-associated NAFLD implied increasing death risk. Future large-scale studies are warranted to further elucidate the correlation between NAFLD and breast cancer prognosis.

Keywords: breast cancer, non-alcoholic fatty liver disease, endocrine therapy, selective estrogen receptor modulator, aromatase inhibitor, liver metastasis