1. For patients diagnosed with breast cancer liver metastases (BCLM), liver function tests were found to be elevated at 6 months prior to detection of metastases.
Evidence Rating Level: 2 (Good)
Breast malignancy is one of the leading causes of cancer-related mortality in women, and 20-30% of patients develop metastases. The liver is a common site of metastasis, and carries one of the lowest 5-year survival rates of 8.5%. Early surgical treatment of breast cancer liver metastases (BCLM) has been shown to improve life expectancy, underlining the importance of early detection. Previous studies have shown elevated liver enzymes at the time of diagnosing BCLM. This current study aimed to identify if markers of liver dysfunction are present before patients were subsequently diagnosed with BCLM. The study population consisted of 104 BCLM patients at a single centre in Vienna, from 1980 to 2019: 66.3% had liver markers measured 6 months before diagnosis, 71.2% at the time of diagnosis and 12 months after diagnosis, and 38.5% with measurements at all time points. The results showed that all of AST, ALT, GGT, LDH, and AP were elevated in 27.9%, 27.5%, 42.0%, 27.6%, and 39.7% of BCLM patients respectively 6 months before diagnosis, which were greater than the null hypothesis of 5% (p < 0.001). The number of liver mets also had a positive correlation with the levels of the above biomarkers at the time of diagnosis. 16.7% of patients had lower albumin, and there was a significantly lower albumin at time of diagnosis for patients who survived less than 12 months, compared to more than 12 months (p = 0.002). Additionally, 7.4% of BCLM patients had elevated bilirubin 6 months before diagnosis, which was not significant (p < 0.373). Overall, this study demonstrated that liver function tests in breast cancer patients could be used as a screen for BCLM, which could lead to earlier detection and treatment.
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