Incidence, Predictors, and Mortality in Patients With Liver Cancer After Fontan Operation
Background Liver cancer (LC) is a serious late complication after the Fontan operation. However, the incidence, predictors, and prognosis remain unknown. The purpose of our study was to determine these clinical characteristics. Methods and Results We assessed liver function in 339 consecutive patien...
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doaj-d22555a1afe840ddb67b76aff4e008c72021-08-27T11:26:33ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-02-0110410.1161/JAHA.120.016617Incidence, Predictors, and Mortality in Patients With Liver Cancer After Fontan OperationHideo Ohuchi0Yohsuke Hayama1Kimiko Nakajima2Kenichi Kurosaki3Isao Shiraishi4Michikazu Nakai5Pediatric Cardiology National Cerebral and Cardiovascular Center Suita Osaka JapanPediatric Cardiology National Cerebral and Cardiovascular Center Suita Osaka JapanPediatric Cardiology National Cerebral and Cardiovascular Center Suita Osaka JapanPediatric Cardiology National Cerebral and Cardiovascular Center Suita Osaka JapanPediatric Cardiology National Cerebral and Cardiovascular Center Suita Osaka JapanCenter for Cerebral and Cardiovascular Disease Information National Cerebral and Cardiovascular Center Suita Osaka JapanBackground Liver cancer (LC) is a serious late complication after the Fontan operation. However, the incidence, predictors, and prognosis remain unknown. The purpose of our study was to determine these clinical characteristics. Methods and Results We assessed liver function in 339 consecutive patients who had undergone the Fontan procedure from 2005 to 2019. LC was histologically diagnosed in 10 patients after a median period of 2.9 years (range: 0.3–13.8; median age: 29.9 years [range: 14.4–41.5 years]; overall median post–Fontan procedure follow‐up: 25.6 years [range: 13–32.1 years]), and the annual incidence was 0.89%. Over the entire post‐Fontan follow‐up period, the annual incidences of new‐onset LC in the second, third, and fourth decades were 0.14%, 0.43%, and 8.83%, respectively. The patients with LC had longer follow‐up periods, higher levels of AFP (α‐fetoprotein), and higher values of liver fibrosis indices (P<0.01–0.0001). Moreover, all indices were predictive of new‐onset LC (P<0.01–0.0001). The LC treatments were surgical resection (n=3), transarterial chemoembolization (n=3), radiofrequency ablation (n=2), and hospice care (n=2). During a median follow‐up of 9.4 months, 4 patients died; the survival rate at 1 year was 60%, and it was better among asymptomatic patients (P<0.01). Conclusions The LC incidence rapidly increased ≥30 years after the Fontan procedure, and liver fibrosis indices and AFP were predictive of new‐onset LC. These LC‐predictive markers should be monitored closely and mandatorily for early LC detection and better prognosis.https://www.ahajournals.org/doi/10.1161/JAHA.120.016617cancerFontan procedurelivermortalitypredictors |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Hideo Ohuchi Yohsuke Hayama Kimiko Nakajima Kenichi Kurosaki Isao Shiraishi Michikazu Nakai |
spellingShingle |
Hideo Ohuchi Yohsuke Hayama Kimiko Nakajima Kenichi Kurosaki Isao Shiraishi Michikazu Nakai Incidence, Predictors, and Mortality in Patients With Liver Cancer After Fontan Operation Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cancer Fontan procedure liver mortality predictors |
author_facet |
Hideo Ohuchi Yohsuke Hayama Kimiko Nakajima Kenichi Kurosaki Isao Shiraishi Michikazu Nakai |
author_sort |
Hideo Ohuchi |
title |
Incidence, Predictors, and Mortality in Patients With Liver Cancer After Fontan Operation |
title_short |
Incidence, Predictors, and Mortality in Patients With Liver Cancer After Fontan Operation |
title_full |
Incidence, Predictors, and Mortality in Patients With Liver Cancer After Fontan Operation |
title_fullStr |
Incidence, Predictors, and Mortality in Patients With Liver Cancer After Fontan Operation |
title_full_unstemmed |
Incidence, Predictors, and Mortality in Patients With Liver Cancer After Fontan Operation |
title_sort |
incidence, predictors, and mortality in patients with liver cancer after fontan operation |
publisher |
Wiley |
series |
Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
issn |
2047-9980 |
publishDate |
2021-02-01 |
description |
Background Liver cancer (LC) is a serious late complication after the Fontan operation. However, the incidence, predictors, and prognosis remain unknown. The purpose of our study was to determine these clinical characteristics. Methods and Results We assessed liver function in 339 consecutive patients who had undergone the Fontan procedure from 2005 to 2019. LC was histologically diagnosed in 10 patients after a median period of 2.9 years (range: 0.3–13.8; median age: 29.9 years [range: 14.4–41.5 years]; overall median post–Fontan procedure follow‐up: 25.6 years [range: 13–32.1 years]), and the annual incidence was 0.89%. Over the entire post‐Fontan follow‐up period, the annual incidences of new‐onset LC in the second, third, and fourth decades were 0.14%, 0.43%, and 8.83%, respectively. The patients with LC had longer follow‐up periods, higher levels of AFP (α‐fetoprotein), and higher values of liver fibrosis indices (P<0.01–0.0001). Moreover, all indices were predictive of new‐onset LC (P<0.01–0.0001). The LC treatments were surgical resection (n=3), transarterial chemoembolization (n=3), radiofrequency ablation (n=2), and hospice care (n=2). During a median follow‐up of 9.4 months, 4 patients died; the survival rate at 1 year was 60%, and it was better among asymptomatic patients (P<0.01). Conclusions The LC incidence rapidly increased ≥30 years after the Fontan procedure, and liver fibrosis indices and AFP were predictive of new‐onset LC. These LC‐predictive markers should be monitored closely and mandatorily for early LC detection and better prognosis. |
topic |
cancer Fontan procedure liver mortality predictors |
url |
https://www.ahajournals.org/doi/10.1161/JAHA.120.016617 |
work_keys_str_mv |
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