Objective:To summarize the clinical features of chemotherapy-induced liver injury(CILI) in breast cancer patients, and to analyze its related influencing factors.Methods:Five hundred and forty-nine breast cancer patients admitted to our hospital and treated with adjuvant chemotherapy from March 2015 to March 2018 were selected. The incidence and clinical characteristics of CILI, and its related influencing factors were investigated and studied.Results:(1) The incidence of liver injury in 549 patients treated with adjuvant chemotherapy for breast cancer was 15.7%, including 69 cases of gradeⅠ, 15 of grade Ⅱ and 2 of grade Ⅲ. (2) CILI occurred in 14 cases of the first cycle, 47 of the second, 23 of the third and in 2 cases of the fourth cycle and over. (3) The incidence of CILI was not significantly correlated with age, mass size,tumor type,axillary lymph node metastasis, histological grade,clinical stage, myelosuppression, hepatitis B virus carriers, hypertension, diabetes, body mass index, smoking and alcohol consumption(P>0.05). Patients with hyperlipidemia, liver metastasis and three-drug combination chemotherapy were more likely to develop CILI(P<0.05). Conclusion:Liver injury of grade I is mainly found in patients treated with adjuvant chemotherapy for breast cancer, its incidence is not high and is prone to occur in the secondcycles of chemotherapy. Three-drug combination chemotherapy should not be conducted in patients with hyperlipidemia and liver metastases. |
[1] 李贺,郑荣寿.2014年中国女性乳腺癌发病与死亡分析[J].中华肿瘤杂志,2018,40(3):166-171.
[2] KULLAK-UBLICK G A,ANDRDE R J,MERZ M,et al.Drug-induced liver injury:recent advances in diagnosis and risk assessment[J].Gut,2017,66:1154-164.
[3] RABINOWICH L,SHIBOLET O.Drug induced steatoheptitis:an uncommon culprit of a common disease[J].Biomed Res Int,2015,2015:168905.
[4] 叶京明, 刘荫华. 2018年NCCN乳腺癌临床实践指南(第1版)更新与回顾[J]. 中华医学杂志, 2018(1):1377-1379.
[5] 中华医学会消化病学分会肝胆疾病协作组.急性药物性肝损伤诊治建议(草案)[J].中华消化杂志,2007,27(11):765-767.
[6] 中华医学会肝病学分会药物性肝病学组. 药物性肝损伤诊治指南[J]. 临床肝胆病杂志, 2015, 31(11):1752-1768.
[7] TAVASSOLI F A,DEVILEE P.The WHO classification of tumors.Pathology genetics,tumors of breast and female genital organs[M].Lyon:IA-RC Press,2003:32-34,36-37.
[8] 曹旭晨,陈策实,陈佳艺,等.中国抗癌协会乳腺癌诊治指南与规范(2017年版)[J].中国癌症杂志,2017,27(9):719.
[9] ZHOU Y,YANG L,LIAO Z,et al.Epidemiology of drug-induced liver injury in China:a systematic analysis of the Chinese literature including 21,789 patients[J].Eur J Gastroenterol Hepatol,2013,25:825-829.
[10] 中国临床肿瘤学会.血液病患者药物性肝损伤的预防和规范化治疗专家共识(2016年版)[J].中华血液学杂志,2016,27(6):441-452.
[11] VIGANO L,DE ROSA G,TOSO C,et al.Reversibility of chemotherapy-related liver injury[J].Hepatol,2017,67(1):84-91.
[12] CHALASANI N P,HAYASHI P H,BONKOSKY H L,et al.Practice Parameters Committee of the American College of Gastroenterology.ACG clinical guideline:the diagnosis and management of idiosyncratic drug-induced liver injury[J].Am J Gastroenterol,2014,109(7):950-966.
[13] WU T,SHAO L,XIN J,et al.Development of diagnostic criteria and a prognostic score for hepatitis B virus related acute on chronic liver failure[J].Gut,2018,67(12):2181-2191.
[14] CHONG C C,WONG G L,LAI P B.Impact of antiviral therapy on post-hepatectomy outcome for hepatitis B-related hepatocellular carcinoma[J].World J Gastroenterol,2014,20(20):6006-6012.
[15] 何勇山,金黑鹰,章金春,等.高脂血症对结直肠癌模型化疗作用影响的实验研究[J].中华胃肠外科杂志,2013,16(6):583-587.
[16] ALBERTI N,BECHADE D,DUPUIS F,et al.Hepar lobatum carcinomatosum associated with liver metastases from breast cancer:report of five cases[J].Diag Interv Imaging,2015,96(1):73-78. |