Objective To systematically review the risk factors for liver injury in breast cancer patients after chemotherapy.

Methods PubMed, Cochrane Library, Embase, Web of Science, CNKI, SinoMed, WanFang Data and VIP databases were electronically searched to collect studies on the influential factors of liver injury in breast cancer patients from inception to March 31, 2024. Two reviewers independently screened the literature, extracted data and evaluated the risk of bias of the included studies. Meta-analysis was performed by using RevMan 5.3 software.

Results A total of 15 studies involving 6,486 patients were included. The results of Meta-analysis showed that hepatitis B virus infection [OR=2.41, 95%CI (1.52, 3.82), P<0.001], lymph node metastasis [OR=1.27, 95%CI(1.05, 1.55), P=0.02],hyperlipidemia[OR=1.58, 95%CI(1.13, 2.20) P=0.007], liver metastasis [OR=3.19, 95%CI(2.11, 4.84), P<0.001], tumor node metastasis (TNM) stage Ⅲ to Ⅳ [OR=1.49, 95%CI(1.17, 1.90), P<0.001], were risk factors for liver injury after breast cancer chemotherapy. Compared with other chemotherapy agents/regimens, the use of fluorouracil [OR=0.58, 95%CI(0.42, 0.80), P<0.001], cyclophosphamide [OR=0.65, 95%CI(0.47, 0.89), P=0.008], AC regimen [OR=0.38, 95%CI(0.22, 0.66), P<0.001] and neoadjuvant chemotherapy [OR=0.61, 95%CI(0.43, 0.88), P=0.007] were associated with a lower risk of liver injury, the use of paclitaxel drugs [OR=2.85, 95%CI(2.31, 3.52),P<0.001], intensive regimen [OR=3.48, 95%CI(2.15, 5.62), P<0.001], TAC regimen [OR=2.42, 95%CI(1.38,4.24), P=0.002] increased the risk of liver injury. Tumor TNM stage Ⅰ [OR=0.63, 95%CI(0.51, 0.78),P=0.001] were protective factors for liver injury after chemotherapy in breast cancer patients.

Conclusion The current evidence shows that multiple factors influence the incidence of liver injury after breast cancer chemotherapy.Medical staff can formulate targeted chemotherapy programs according to the influencing factors and clinical characteristics to reduce the risk of liver injury after chemotherapy.

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