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High early mortality after percutaneous liver biopsy in metastatic cancer: national analysis
  1. Dominic Stephen King1,
  2. Benjamin Coupland2,
  3. Jemma Mytton2,
  4. John Speakman3,
  5. Anna Lock4,
  6. Nikhil Sanyal5,
  7. Louisa Nelms6,
  8. Sophie Rayner7,8,
  9. Veronica Nanton9,
  10. Amandeep Dosanjh2,
  11. Prashant Patel10 and
  12. Nigel Trudgill11,12
  1. 1Department of Gastroenterology, Russells Hall Hospital, Dudley, UK
  2. 2Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  3. 3Department of Palliative Care, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  4. 4Department of Palliative Care, Sandwell & West Birmingham NHS Trust, West Bromwich, UK
  5. 5Department of Palliative Care, George Eliot Hospital NHS Trust, Nuneaton, UK
  6. 6Department of Palliative Care, Severn Hospice, Shrewsbury, UK
  7. 7St Lukes Hospice Plymouth, Plymouth, UK
  8. 8Department of Palliative Care, University Hospitals Plymouth NHS Trust, Plymouth, UK
  9. 9Gibbet Hill Campus, University of Warwick, Health Sciences, Medical School Building, Coventry, UK
  10. 10University of Birmingham, Birmingham, UK
  11. 11Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
  12. 12Department of Gastroenterology, Sandwell & West Birmingham NHS Trust, West Bromwich, UK
  1. Correspondence to Professor Nigel Trudgill, Department of Gastroenterology, Sandwell and West Birmingham NHS Trust, West Bromwich, UK; nigel.trudgill{at}nhs.net

Abstract

Objective The study aimed to assess outcomes in patients undergoing liver biopsy for metastatic cancer, focusing on mortality rates and chemotherapy following their biopsy.

Methods Hospital Episode Statistics data from 2010 to 2019 identified 30 992 patients with metastatic cancer who underwent percutaneous liver biopsy. Primary outcomes included 14-day and 30-day mortality rates, as well as the proportion receiving chemotherapy within 6 months.

Results 30 992 patients were studied (median age of 69 (IQR 59–74) years, 52% female). 28% underwent inpatient biopsy with 8% dying within 14 days and 26% within 30 days. Outpatient biopsies had lower mortality rates: 2.2% at 14 days and 8.6% at 30 days.

30-day mortality was associated with: inpatient biopsy (OR 3.5 (95% CI 3.26 to 3.76)) and increasing comorbidity (Charlson score 1–4: 1.21 (95% CI 1.11 to 1.32)); but negatively with all ages under 70 (eg, for 18–29 years 0.35 (95% CI 0.20 to 0.63)) and biopsy at a radiotherapy centre (0.88 (95% CI 0.82 to 0.95)).

46% of patients received chemotherapy within 6 months of biopsy (53% with outpatient biopsies but only 33% with inpatient biopsies). Receiving chemotherapy was associated with: all ages under 70 (eg, 18–29 years 3.3 (95% CI 2.62 to 5.30)), female sex (1.06 (95% CI 1.01 to 1.11)) and medium (1.13 (95% CI 1.04 to 1.22) and high (1.49 (95% CI 1.38 to 1.62)) volume liver biopsy providers; but negatively with inpatient biopsy (0.45 (95% CI 0.43 to 0.48)) and increasing comorbidity (Charlson score 1–4: 0.85 (95% CI 0.79 to 0.91)).

Conclusions Mortality rates following liver biopsy for metastatic cancer are notably higher among patients undergoing emergency inpatient procedures. Clinicians should carefully weigh the risks and benefits of biopsy in elderly, comorbid or poor performance status patients. Multidisciplinary approaches involving palliative care may aid in decision-making for these patients.

  • Cancer
  • Clinical decisions
  • End of life care
  • Palliative Care
  • Quality of life

Data availability statement

No data are available.

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Footnotes

  • Contributors DSK, VN, PP, AD and NT jointly conceived the project. BC extracted the data and DSK, BC, JM and NT analysed the data. DSK, NS, LN, SR and NT drafted the manuscript, and all authors critically appraised the approved the manuscript. NT is the guarantor for this work.

  • Funding This work was supported by the Upper GI blues charity, Sandwell & West Birmingham NHS Trust.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.