Liver diseases in Adult Life after Childhood Cancer in Scandinavia (ALiCCS): A population‐based cohort study of 32,839 one‐year survivors

Abstract

Information on late onset liver complications after childhood cancer is scarce. To ensure an appropriate follow-up of childhood cancer survivors and reducing late liver complications, the need for comprehensive and accurate information is presented. We evaluate the risk of liver diseases in a large childhood cancer survivor cohort. We included all 1-year survivors of childhood cancer treated in the five Nordic countries. A Cox proportional hazards model was used to estimate hospitalisation rate (hazard) ratios (HRs) for each liver outcome according to type of cancer. We used the risk among survivors of central nervous system tumour as internal reference. With a median follow-up time of 10 years, 659 (2%) survivors had been hospitalised at least once for a liver disease. The risk for hospitalisation for any liver disease was high after hepatic tumour (HR = 6.9) and leukaemia (HR = 1.7). The Danish sub-cohort of leukaemia treated with haematopoietic stem cell transplantation had a substantially higher risk for hospitalisation for all liver diseases combined (HR = 3.8). Viral hepatitis accounted for 286 of 659 hospitalisations corresponding to 43% of all survivors hospitalised for liver disease. The 20-year cumulative risk of viral hepatitis was 1.8% for survivors diagnosed with cancer before 1990 but only 0.3% for those diagnosed after 1990. The risk of liver disease was low but significantly increased among survivors of hepatic tumours and leukaemia. Further studies with focus on the different treatment modalities are needed to further strengthen the prevention of treatment-induced late liver complications.

Biliary Rhabdomyosarcoma in Pediatric Patients: A Systematic Review and Meta-Analysis of Individual Patient Data

“…Late adverse effects of RT in children have been shown by many studies (51)(52)(53). This has special implications in pediatric patients with BRMS, as unavoidable hepatotoxicity of chemotherapy is aggravated by liver radiation (33,39,40,54,55). EBRT involving the liver has been identified as independent risk factor for acute and late hepatic complications (39,40,55).…”

The role of liver resection in metastatic nephroblastoma: a systematic review and Meta-regression analysis

“…Concerning late sequelae of liver resection in pediatric patients, the follow up period of the included studies in our review was too short to gain insights. In large cohort studies of long-term effects of cancer treatment in pediatric oncological patients, abdominal surgery, including liver surgery, was not an independent predictor of liver-specific nor gastrointestinal morbidity in adult life [ 49 , 50 ]. Overall, initial evidence generated by our study suggests that liver resection of WTLM in children has a moderate risk profile.…”