Thesis (M.Sc.) - Cairo University - National Cancer Institute - Department of Pediatric Oncology

Background: Objectives: Pediatric cancer patients are high risk for HCV infection and assessment of liverinjury and fibrosis is crucial either using invasive or non-invasive methods. The study objective was toassess the validity of non-invasive tools as APRI and fibroscan on assessment of liver fibrosis and compare it against the histopathological findings in the biopsied patients. Patientsandmethods:This is a retrospective study , included seventy-one paediatric cancer patients with chronic HCV infection with or without HBV co-infection and treated at the paediatric oncology department, National Cancer Institute, Cairo university , between January 2008 and December 2016. All patients were assessed fordegree of liverinjury using fibroscan and other non invasive tools as APRI and FIB4(biochemical markers).Patients with hematological and solid malignancies ranged from 1-18 years old, ended their chemotherapy for at least one year and did not receive any antiviral therapy before initial assessment. Results: Initial fibroscan results showed that 58 patients (81.7%) had no or mild fibrosis (F0-F2) while 13 patients (18.3%) had advanced fibrosis or cirrhosis (F3-F4).Follow up fibroscan assessment showed that 61 patients (85.9%) ,52 patients (88.1%) had no or mild fibrosis(F0-F2) and 10 patients ( 14.1%), 7 patients (11.9%) had fibrosis or cirrhosis (F3-F4) on first and second scans respectively.Thirty one patients had liver biopsy ,the diagnostic accuracy of fibroscan to diagnose fibrosis compared to liver biopsy (gold standard),showed 86.7% sensitivity,100% specificity, PPV100%, NPV was 88.9% and accuracy was 93.5%.Acute lymphoblastic leukemia was the most common diagnosis associated with transaminitis and also patients received methotrexate and 6mp during maintenance therapy were highly associated with transaminitis.Independent variables to predict fibrosis using initial fibroscanwere acute lymphoblastic leukemia, high value of FIB4,APRI above cutoff >1.75,2.17 respectively

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