Chemotherapy-induced liver injury in Tibetan breast cancer patients: clinical features and risk factor analysis

To conduct the first analysis of the clinical characteristics and factors affecting drug-induced liver injury following neoadjuvant and adjuvant chemotherapy for breast cancer in the Xizang region.

Overall, 246 patients with breast cancer diagnosed and treated at the People's Hospital of Tibet Autonomous Region from June 2016 to August 2023 were retrospectively analyzed, among whom 71 patients received neoadjuvant or adjuvant chemotherapy. Liver injury was defined as elevated levels of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, or total bilirubin beyond the upper limit of normal from the initiation of chemotherapy to 3 months post-chemotherapy. The severity was assessed according to Common Terminology Criteria for Adverse Events v5.0. Cases with alternative etiologies, such as viral hepatitis reactivation, were excluded. Factors influencing drug-induced liver injury were analyzed. A univariate analysis was conducted using the chi-square test, whereas a multivariate analysis was performed using logistic regression. The difference was considered statistically significant at p<0.05.

The median age of all patients was 51 years (range, 28-71 years). Liver injury was observed in 37 cases (52.1%), and 89.2% of them had Grade I-II injury. Both univariate and multivariate analyses suggested that receiving concomitant anti-HER-2 targeted therapy (OR=6.290, 95%CI: 1.617-24.472, p=0.008) was a risk factor for chemotherapy-induced liver injury.

Receiving concurrent anti-HER-2 targeted therapy is a major risk factor for post-chemotherapy liver function injury for patients with breast cancer in the Xizang region, and the monitoring of liver function levels should be strengthened in such patients.