High early mortality after percutaneous liver biopsy in metastatic cancer: national analysis

Dominic Stephen King; Benjamin Coupland; Jemma Mytton; John Speakman; Anna Lock; Nikhil Sanyal; Louisa Nelms; Sophie Rayner; Veronica Nanton; Amandeep Dosanjh; Prashant Patel; Nigel Trudgill

doi:10.1136/spcare-2024-004936

High early mortality after percutaneous liver biopsy in metastatic cancer: national analysis

BMJ Support Palliat Care. 2024 Aug 1:spcare-2024-004936. doi: 10.1136/spcare-2024-004936. Online ahead of print.

Authors

Dominic Stephen King¹, Benjamin Coupland², Jemma Mytton², John Speakman³, Anna Lock⁴, Nikhil Sanyal⁵, Louisa Nelms⁶, Sophie Rayner^{7

8}, Veronica Nanton⁹, Amandeep Dosanjh², Prashant Patel¹⁰, Nigel Trudgill^{11

12}

Affiliations

¹ Department of Gastroenterology, Russells Hall Hospital, Dudley, UK.
² Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
³ Department of Palliative Care, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
⁴ Department of Palliative Care, Sandwell & West Birmingham NHS Trust, West Bromwich, UK.
⁵ Department of Palliative Care, George Eliot Hospital NHS Trust, Nuneaton, UK.
⁶ Department of Palliative Care, Severn Hospice, Shrewsbury, UK.
⁷ St Lukes Hospice Plymouth, Plymouth, UK.
⁸ Department of Palliative Care, University Hospitals Plymouth NHS Trust, Plymouth, UK.
⁹ Gibbet Hill Campus, University of Warwick, Health Sciences, Medical School Building, Coventry, UK.
¹⁰ University of Birmingham, Birmingham, UK.
¹¹ Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK nigel.trudgill@nhs.net.
¹² Department of Gastroenterology, Sandwell & West Birmingham NHS Trust, West Bromwich, UK.

PMID: 39089725
DOI: 10.1136/spcare-2024-004936

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.

Keywords: Cancer; Clinical decisions; End of life care; Palliative Care; Quality of life.