Hepatic steatosis and fibrosis are associated with metabolic factors rather than endocrine therapy in breast cancer patients

Background: Steatotic liver disease (SLD) is prevalent among women with breast cancer, but the influence of hormonotherapy on its severity and progression remains uncertain. This study evaluated the prevalence, severity, and predictors of SLD in relation to hormone therapy. Methods: In this cross-sectional study, women with breast cancer were stratified by endocrine therapy exposure and evaluated with liver transient elastography and ultrasound. A subset of patients exposed to hormone therapy was prospectively followed for approximately 24 months to assess changes in liver stiffness over time. Results: Among 171 women [mean age 58±10 years; median follow-up 53 months (range, 1-315 months)], comorbidities included diabetes (26.9%), hypertension (53.2%), dyslipidemia (31.0%), and obesity (70.2%). Patients were divided into four groups: no hormone therapy (n=55, 32.2%), tamoxifen only (n=72, 42.1%), anastrozole only (n=16, 9.4%), and both drugs (n=28, 16.4%). SLD was present in 57.9% of participants, with no significant differences in steatosis prevalence (P=0.09) or liver stiffness (P=0.20) across groups. Liver stiffness ≥8 kPa occurred in 12.3%, and stiffness ≥12 kPa in 5.8%. Diabetes was independently associated with steatosis, and metabolic syndrome with advanced fibrosis, regardless of hormone therapy duration. Among 35 patients in the prospective sub-cohort, no significant changes in liver stiffness were detected after 24 months of continuous endocrine therapy. Conclusions: Over half of the participants had SLD, with advanced fibrosis in ~10%. Metabolic factors were independently associated with SLD development and progression, regardless of hormone therapy exposure. Patients in continuous use of endocrine therapy had no dynamic changes in liver stiffness after 24 months of follow-up.