Cancer survivors face risk of liver cirrhosis and die young

The risk of developing liver cirrhosis upon first cancer surgery and prolonging life is higher among patients with cancer survivors who are under the age of 60 years, but the treatment response does not vary much between age groups, according to a study published in JAMA Oncology.

These findings highlight the need for preventive treatment as well as a better understanding of the risk born by patients diagnosed with cancer, said Dr. Amit Kocher, lead author of the study and vice-Head of Cancer Research at Hospital Universitario La Princesa de Madrid.

Evaluating and assessing the clinical relevance of the results of previous studies will be needed to determine whether the findings relate to the treatment interventions.

Potential differences identified in the study between age groups include patients with early-stage cancers required surgery for as long as the disease is underway depending on treatment. Patients diagnosed with advanced cancers requiring liver transplant often require a longer time to achieve therapeutic responses in the blood, which is greater risk-adjusted for the overall class of drugs used.

For the study, 14,577 patients who underwent hepatocellular carcinoma invasive versus standard-of-care therapy in 1993-2017 were followed for 5-year periods, with a follow-up for two additional years, between 2011 and 2017.

The survival rates of patients diagnosed with advanced lesions of the liver were 16.5% (6,720) for those without the cancer, 10.2% (15,219) for the advanced group and 8.9% (11,985) for the control group. The median age of the surviving patients was 63 years (95% CI, 60.2-129.0). Patients who were diagnosed in the past year were 73 years (95% CI, 61.7-191.5) years, and observatory mortality was 0.8%–1.4%.

Some age groups had worse response compared with those of the control group (14.1% vs. 12.8%; P less than .001; P that interaction of age and treatment group was significant; P less than .00001).In contrast, patients with advanced liver cancer were less likely to become chronically ill with cirrhosis, with a rate of 0.8% vs. 1.8%; P less than .001; P less than .00001; and the rate of chronic disease was 4% vs. 8%; P less than .00001.

Overall, cancer survivors had a 70%+ lower risk of developing liver cirrhosis versus controls (P less than .00001). When the analysis was adjusted for sex, number of smoked cigarettes smoked per day, use of alcohol or other drugs and other chronic diseases and socioeconomic factors, the relative risk of liver cirrhosis in cancer survivors was significantly higher than in controls (RR = 0.37; 95% CI, 0.10-0.88; P less than .00001).The results were similar when excluding patients with cardiovascular disease, which represented 65.2%, and cancer patients who migrated to hospitals from where they were treated.

Patients with liver failure were 25% more likely to develop cirrhosis, the researchers said.

Estimates based on the rate of disability over the first 5 years after diagnosis, as calculated by the National Institute for Health Research Haemostat estimating patient lifespan (given the proportion of patients with extensive cognitive impairment, do not accurately represent patient lifespan), suggest that there will be 46.2 million new cases of liver cirrhosis and 83,000 deaths caused annually during the first 5 years after diagnosis, the investigators said.