Analysis of clinical characteristics and risk factors of liver injury in treatment-naïve patients with lung cancer

The incidence of anticancer drug-induced liver injury (DILI) is increasing with novel antineoplastic agents. In this retrospective cohort of 709 treatment-naïve lung cancer patients receiving antineoplastic therapy with regular follow-up at the First Affiliated Hospital of Nanchang University (2023.1.1–2023.12.31), 243 developed anticancer DILI. Demographic, clinical, and treatment variables were collected and analyzed. Most anticancer DILI patients were male (2.92:1 ratio). Liver injury primarily occurred within 8 weeks of initial treatment. 42 patients developed acute DILI (45.24% hepatocellular injury), while 201 presented with drug-induced liver biochemical abnormalities (46.77% cholestatic injury, 46.27% mixed injury). Acute DILI had a lower cure rate than drug-induced liver biochemical abnormalities (33.33% vs. 46.77%, P = 0.036). 28 patients developed chronic DILI, predominantly of the cholestatic injury. Multivariable regression analysis identified abnormal baseline liver function (odds ratio [OR] = 3.50, 95% confidence interval [CI] 1.94–6.30, P < 0.001), pre-existing liver disease (OR = 1.51, 95% CI 1.00–2.26, P = 0.049) and specific antineoplastic treatment regimens (compared with immunotherapy alone)—chemotherapy combined with immunotherapy (OR = 4.53, 95% CI 1.32–15.55, P = 0.016), chemotherapy with targeted therapy (OR = 5.16, 95% CI 1.45–18.37, P = 0.011), and chemotherapy alone (OR = 5.95, 95% CI 1.62–21.76, P = 0.007)—as independent risk factors for anticancer DILI. The associations for abnormal baseline liver function, chemotherapy alone, and chemoimmunotherapy remained generally consistent in sensitivity analyses. These findings support pretreatment assessment of liver biochemistry and closer monitoring of patients with baseline abnormalities, pre-existing liver disease, or exposure to chemotherapy-containing regimens, particularly during the early treatment period.