Article Text
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.
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