老年乳腺癌化疗致肝损伤对患者生活质量的影响及其危险因素

Influence of chemotherapy-induced liver injury on quality of life of elderly patients with breast cancer and its risk factors

【摘要】目的 探讨老年乳腺癌化疗致肝损伤对患者生活质量的影响,分析导致肝损伤的危险因素。方法 选取2021年1月至2022年9月运城市中心医院收治的226例行规范化疗的老年乳腺癌患者为研究对象,以美国卫生及公共服务部常见不良反应事件评价标准4.0版(CTCAE4.0)评估肝损伤情况,根据结果将患者分为肝损伤组(58例)与无肝损伤组(168例),使用乳腺癌患者生命质量测定量表(FACT-B)比较两组患者的生活质量,比较两组1年生存率。使用SPSS 24.0统计软件进行数据分析。根据数据类型,分别采用χ²检验、t检验或秩和检验进行组间比较。使用logistic回归分析评估老年乳腺癌患者化疗致肝损伤的影响因素。结果 肝损伤组生理状况、功能状况、乳腺癌特异模块FACT-B评分及FACT-B总分均低于无肝损伤组,差异有统计学意义(P＜0.05)。logistic回归分析显示,密集化疗(OR=5.425,95%CI 3.227～9.120；P＜0.05)和化疗方案为蒽环类+紫杉醇类(OR=3.367,95%CI 1.881～6.028；P＜0.05)均为老年乳腺癌患者化疗致肝损伤的危险因素。随访1年,剔除14例失访病例,肝损伤组1年生存率为86.79%(46/53),无肝损伤组1年生存率为94.97%(151/159),两组比较,差异无统计学意义(P＞0.05)。结论 化疗致肝损伤的老年乳腺癌患者生活质量下降,密集化疗及蒽环类、紫杉醇类联合化疗可能导致肝损伤风险升高,化疗致肝损伤对预后生存的影响还需后续研究的进一步观察。

基金项目:山西省医学重点科研项目(2022XM59)

【Abstract】Objective To determine the influence of chemotherapy-induced liver injury on quality of life in elderly patients with breast cancer, and to analyze the risk factors for liver injury. Methods A total of 226 elderly patients with breast cancer who underwent standard chemotherapy in our hospital from January 2021 to September 2022 were enrolled, and according to their liver injury evaluated with common terminology criteria for adverse events version 4.0 (CTCAE4.0) of United States Department of Health and Human Services, they were divided into liver injury group (58 cases) and non-liver injury group (168 cases). Functional assessment of cancer therapy-breast (FACT-B) was applied to compare the quality of life between the two groups of patients. The one-year survival rate was also compared between them. SPSS statistics 24.0 was used for data analysis. Depending on data type, Chi-square test, student′s t test or rank sum test was employed for intergroup comparison. Logistic regression analysis was applied to assess the influencing factors for chemotherapy-induced liver injury in elderly patients with breast cancer. Results The scores of physiological status, functional status and breast cancer-specific module and total score of FACT-B were significantly lower in the liver injury group than the non-liver injury group (P<0.05). Logistic regression analysis showed that intensive chemotherapy (OR=5.425,95%CI 3.227-9.120; P<0.05) and chemotherapy regimen of anthracyclines + taxanes (OR=3.367,95%CI 1.881-6.028; P<0.05) were the risk factors for chemotherapy-induced liver injury in elderly patients with breast cancer. After one year of follow-up, 14 cases of missing follow-up were eliminated, and the one-year survival rate was 86.79% (46/53) in the liver injury group and 94.97% (151/159) in the non-liver injury group, but there was no statistical difference between them (P>0.05). Conclusion Chemotherapy-induced liver injury cause a decrease in the quality of life of elderly breast cancer patients. Intensive chemotherapy and combined chemotherapy of anthracyclines and taxanes may increase the risk of liver injury. But further observation is needed to determine the effect of chemotherapy-induced liver injury on prognosis in future.

This work was supported by the Key Medical Research Project of Shanxi Province (2022XM59).