Pediatric blood & cancer · 2026
Liver-Related Late Effects in Long-Term Survivors of High-Risk Neuroblastoma: Insights From a Comprehensive Prospective Follow-Up Study.
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Zarfati Angelo, Romano Giorgia, Crocoli Alessandro, Monti Lidia, Persano Giorgio, Grimaldi Piercesare, Rollo Giovanni, Soglia Giovanna, Di Giannatale Angela, Serra Annalisa, Pietrobattista Andrea, De Ioris Maria Antonietta, Grimaldi Chiara
Аннотация
BACKGROUND: Therapeutic advances in pediatric oncology have significantly improved overall survival, with a higher incidence of long-term adverse effects and sequelae. Among pediatric cancer survivors, the highest incidence of hepatic lesions has been observed in those previously treated for high-risk neuroblastoma (HRNB). While hepatic nodules in these patients historically raised concern for tumor locations, recent attention has shifted toward non-tumoral, late-onset hepatic sequelae.
METHODS: In this study, we retrospectively reviewed long-term liver outcomes from an institutional perspective follow-up protocol, including long-term HRNB survivors (>5 years from diagnosis) treated between 1996 and 2018 at a tertiary pediatric center.
RESULTS: A total of 47 patients were included, with a median follow-up of 11.1 years. Liver parenchyma was normal in 11 (23%) patients throughout the whole follow-up period. Diffuse parenchymal inhomogeneity was observed in 36 patients out of 47 (76%). Out of 36 patients, 16 showed a stable, diffuse, non-nodular alteration of the liver during the whole follow-up period, while in seven patients, the liver involvement completely regressed after a median of 2.8 years. Moreover, 13 out of 36 patients (36%) with diffuse parenchymal inhomogeneity developed nodular lesions after a median of 7.7 years from diagnosis and 1.7 years from the onset of parenchymal alterations. Alpha-fetoprotein levels were normal in all patients.
CONCLUSIONS: A structured, integrated, multidisciplinary follow-up program revealed an unexpectedly high prevalence of hepatic abnormalities on imaging. Further studies are needed to define the long-term risk of developing liver complications, both in terms of malignancy and functional impairment.
METHODS: In this study, we retrospectively reviewed long-term liver outcomes from an institutional perspective follow-up protocol, including long-term HRNB survivors (>5 years from diagnosis) treated between 1996 and 2018 at a tertiary pediatric center.
RESULTS: A total of 47 patients were included, with a median follow-up of 11.1 years. Liver parenchyma was normal in 11 (23%) patients throughout the whole follow-up period. Diffuse parenchymal inhomogeneity was observed in 36 patients out of 47 (76%). Out of 36 patients, 16 showed a stable, diffuse, non-nodular alteration of the liver during the whole follow-up period, while in seven patients, the liver involvement completely regressed after a median of 2.8 years. Moreover, 13 out of 36 patients (36%) with diffuse parenchymal inhomogeneity developed nodular lesions after a median of 7.7 years from diagnosis and 1.7 years from the onset of parenchymal alterations. Alpha-fetoprotein levels were normal in all patients.
CONCLUSIONS: A structured, integrated, multidisciplinary follow-up program revealed an unexpectedly high prevalence of hepatic abnormalities on imaging. Further studies are needed to define the long-term risk of developing liver complications, both in terms of malignancy and functional impairment.