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Int J Cancer. 2018 Feb 15;142(4):702-708. doi: 10.1002/ijc.31093. Epub 2017 Nov 7.

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

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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.
Department of Clinical Sciences, Paediatric Oncology and Haematology, Skåne University Hospital, Lund University, Lund, Sweden.
Finnish Cancer Registry, Pieni Roobertinkatu 9, Helsinki, 00130, Finland.
Department of Paediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Faculty of Medicine, Laeknagardur, University of Iceland, Reykjavik, Iceland.
The Icelandic Cancer Registry, Skogarhlid 9, PO Box 5420, Reykjavik, 125, Iceland.
Cancer Registry of Norway, P.O. Box 5313, Majorstuen, Oslo, Norway.
Department of Paediatrics, Oslo University Hospital, Postboks 4950 Nydalen, 0424, Oslo.
Medical Faculty, University of Oslo, P.O box 1078, Blindern, 0316, Oslo.
Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark.


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.

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