Department of Paediatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Denmark.
Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen, 2100, Denmark.
Int J Cancer. 2018 Feb 15;142(4):702-708. doi: 10.1002/ijc.31093. Epub 2017 Nov 7.
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.
关于儿童癌症后迟发性肝脏并发症的信息很少。为了确保对儿童癌症幸存者进行适当的随访并减少迟发性肝脏并发症,需要提供全面和准确的信息。我们评估了大型儿童癌症幸存者队列中的肝脏疾病风险。我们纳入了在北欧五国接受治疗的所有 1 年儿童癌症幸存者。使用 Cox 比例风险模型根据癌症类型估算每种肝脏结局的住院率(风险)比(HR)。我们使用中枢神经系统肿瘤幸存者的风险作为内部参考。中位随访时间为 10 年,659 名(2%)幸存者至少因肝脏疾病住院一次。肝肿瘤(HR=6.9)和白血病(HR=1.7)后发生任何肝脏疾病的住院风险很高。接受造血干细胞移植治疗的白血病丹麦亚组所有肝脏疾病联合住院的风险显著更高(HR=3.8)。病毒性肝炎占 659 次住院中的 286 次,占所有因肝脏疾病住院的幸存者的 43%。1990 年前诊断出癌症的幸存者 20 年累积病毒性肝炎风险为 1.8%,而 1990 年后诊断出癌症的幸存者风险仅为 0.3%。肝脏疾病的风险虽然较低,但在肝肿瘤和白血病幸存者中显著增加。需要进一步研究不同的治疗方式,以进一步加强对治疗引起的迟发性肝脏并发症的预防。