E51: The association between cirrhosis and outcomes amongst female patients undergoing surgery for breast cancer in Ontario: a population-based study

Introduction: The relationship between cirrhosis and breast cancer treatment and outcomes has not been specifically explored. We evaluated the association between cirrhosis and surgical outcomes in female patients with breast cancer.

 

Methods:

Methods:  We performed a retrospective cohort study of female patients undergoing surgery for breast cancer between 2007-2018 using health administrative data from Ontario, Canada.  Overall and cancer-specific survival from time of surgery to December 2021 and association between cirrhosis status and 90-day post-operative mortality was compared between patients with and without cirrhosis

Results:

Results:  A total of 910 patients with breast cancer and cirrhosis were compared to 82,970 patients with breast cancer but without cirrhosis. The median age of diagnosis was 65 years in patients with cirrhosis, and 61 years in those without (p< 0.001). The most common etiology of cirrhosis was non-alcoholic fatty liver disease (n = 602, 66%) followed by alcohol-related (n = 144, 16%). Model for end stage liver disease score (MELD-Na) was available in 24% (n = 218), with a median score of 8 (IQR 6 – 11). Patients with cirrhosis had similar breast cancer stage at diagnosis as patients without cirrhosis (47% stage 1, 38% stage 2, 11% stage 3, and 0.5% stage 4). Use of pre-operative chemotherapy was less common in patients with cirrhosis (5.9% vs 7.9%, p=0.026). Post-operative radiation and chemotherapy within 6-months after surgery was slightly lower in patients with cirrhosis (56.8% vs 63.7%, p< 0.001) and (48.4% vs 52.2%, p=0.019) respectively. Patients with cirrhosis had higher 90-day post-operative mortality in comparison to those without (1.4% vs 0.3%, p < 0.001). After adjusting for age, income quintile, and breast cancer surgery, cirrhosis was independently associated with 90-day post-operative mortality (RR, 4.1; 95% CI 2.4-6.8). Survival in patients with cirrhosis was lower than those without (5-year OS 77% vs 87%, p< 0.0001); stage 1 83% vs 94%, stage 2 75% vs 87%, stage 3 62% vs 73%, stage 4 40% vs 40%). Cancer-specific survival was also lower in patients with cirrhosis (5-year CSS 88% vs 91%, p=0.017

Conclusions:

Conclusion:  This large population-based study demonstrates that, compared to patients without cirrhosis, patients with cirrhosis are older with similar stage at diagnosis, but are somewhat less likely to receive adjuvant therapies. While they have lower overall and cancer-specific survival, their outcomes remain favourable and should be considered for curative-intent therapies.