ABSTRACT
Objective:To explore the risk factors of fatty liver occurrence in postoperative breast cancer patients after endocrine therapy, and establish a risk prediction model.Methods:A total of 120 breast cancer patients who received endocrine therapy after surgery in Huanggang Central Hospital from June 2014 to June 2016 were retrospectively selected, and another 120 breast cancer patients who did not receive endocrine therapy after surgery in the same period were selected as the control group. The difference of prognosis between patients treated with endocrine therapy or not was compared. According to the occurrence of fatty liver after endocrine therapy, the patients were divided into fatty liver group (63 cases) and non-fatty liver group (57 cases). Multivariate logistic regression was used to analyze the risk factors of fatty liver occurrence after endocrine therapy. Based on the risk factors, R 3.3.2 software was used to establish a nomogram prediction model. The Harrell consistency index and receiver operating characteristic (ROC) curve (with imageological diagnosis as the "gold standard") were used to analyze the effect of the model on predicting the occurrence of fatty liver, and the calibration curve was used to evaluate the consistency between the model prediction and the actual situation.Results:The recurrence and metastasis rate and mortality rate of patients with endocrine therapy were lower than those of patients without endocrine therapy, and the 3-year and 5-year disease-free survival rates and overall survival rates were higher than those of patients without endocrine therapy (all P < 0.05). Compared with the non-fatty liver group, the levels of alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TBIL), total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and body mass index (BMI) in the fatty liver group increased (all P < 0.05), while the level of high-density lipoprotein cholesterol (HDL-C) decreased ( P < 0.05). Multivariate logistic regression analysis showed that increased ALT [ OR = 4.680 (95% CI 3.621-5.738)], AST [ OR = 4.862 (95% CI 3.809-5.914)], TBIL [ OR = 3.808 (95 % CI 2.754-4.861)], TC [ OR = 4.294 (95% CI 3.320-5.267)], TG [ OR = 3.401 (95% CI 2.442-4.359)], LDL-C [ OR = 2.976 (95% CI 2.037-3.916)], BMI [ OR = 4.082 (95% CI 3.118-5.045)] and decreased HDL-C [ OR = 0.930 (95% CI 0.876-0.983)] were independent risk factors for fatty liver occurrence after endocrine therapy (all P < 0.05). The consistency index of the nomogram model was 0.792 (95% CI 0.721-0.863), and the area under the ROC curve (AUC) of the nomogram model to judge the occurrence of fatty liver was 0.810 (95% CI 0.734-0.886), indicating that the model had a good discrimination between fatty liver and non-fatty liver. The evaluation of calibration curve showed that the nomogram model for prediction of fatty liver had a good consistency with the actual occurrence of fatty liver. Conclusions:Increased ALT, AST, TBIL, TC, TG, LDL-C, BMI and decreased HDL-C are risk factors for fatty liver occurrence after endocrine therapy in postoperative breast cancer patients. The nomogram model based on risk factors has a good effect on predicting the occurrence of fatty liver.