Hepatitis B virus screening and reactivation and management of patients with nasopharyngeal carcinoma: A large‐scale, big‐data intelligence platform–based analysis from an endemic area

Abstract

BACKGROUND: Chemotherapy, target therapy, and immunotherapy are increasingly being used in the systematic treatment of nasopharyngeal carcinoma (NPC), during which the occurrence of hepatitis B virus (HBV) reactivation might increase. However, data regarding HBV screening and reactivation and the clinical management of NPC patients with HBV infections are lacking. This study was aimed at clarifying the risk of reactivation for NPC patients on different regimens while providing evidence concerning HBV screening and management in an endemic area. METHODS: With the NPC database from an established big-data intelligence platform at Sun Yat-Sen University Cancer Center in China, NPC patients who were diagnosed between 2008 and 2016 and underwent HBV screening and regular monitoring of liver enzymes and HBV deoxyribonucleic acid (DNA) were analyzed. RESULTS: Among the 46,919 patients identified, the HBV screening rate was 24.8% (11,616 of 46,919). Among the screened patients with an HBV infection, regular monitoring of liver enzymes and HBV DNA occurred for 563 patients. The incidence of HBV reactivation and HBV-related hepatitis was 9.1% (51 of 563) and 2.5% (14 of 563), respectively. The reactivation risk varied for different treatments and regimens and ranged from 0.0% to 21.4%. Detectable baseline HBV DNA (odds ratio [OR], 2.93; P < .01), the presence of liver metastasis at diagnosis (OR, 7.19; P < .01), and antiviral prophylaxis (OR, 0.29; P < .01) were significantly associated with reactivation. CONCLUSIONS: In NPC patients with chronic HBV infections on high-risk regimens, the reactivation risk is similar to or exceeds the risk associated with other immunosuppressive therapies for which screening and prophylaxis are recommended. Our findings, therefore, support HBV screening and prophylaxis for these patients, whereas regular monitoring might be appropriate for patients with resolved HBV infections or those receiving low-risk regimens. Cancer 2017;123:3540-9.

Spontaneous remission of residual post‐therapy plasma Epstein–Barr virus DNA and its prognostic implication in nasopharyngeal carcinoma: A large‐scale, big‐data intelligence platform‐based analysis

“…Patient demographics and diagnostic and therapeutic information were obtained from the intelligence platform using search terms including ‘diagnosis’, ‘histology type’, ‘age at first diagnosis’, ‘sex’, ‘disease stage’, ‘radiotherapy method’, ‘chemotherapy regimen’ and ‘EBV DNA’. A detailed description of this intelligence platform was presented in our previously published research . In brief, this novel ‘big data’ research system enables the automatic organization, integration, re‐structuring and updating of real‐time data from a number of clinical business systems, based on a well‐designed data model and algorithm.…”

Prognostic value of nutritional risk screening 2002 scale in nasopharyngeal carcinoma: A large‐scale cohort study

“…We employed a big‐data intelligence database, which has been described in detail previously (Yiducloud Technology, Beijing, China), at Sun Yat‐sen University Cancer Center to identify eligible patients between 2009 and 2013 (Figure ). Inclusion criteria were: (i) newly diagnosed non‐disseminated NPC; (ii) World Health Organization (WHO) pathology type II/III; (iii) Karnosfky performance score ≥70; (iv) receiving IMRT; (v) if receiving concurrent chemotherapy, single‐agent cisplatin only; (vi) weekly assessment of weight and biochemical profiles; and (vii) no other malignancies or previous radiotherapy or chemotherapy.…”

Competing risk nomograms for nasopharyngeal carcinoma in the intensity-modulated radiotherapy era: A big-data, intelligence platform-based analysis

“…This retrospective study was based on the NPC-specific database from the big-data intelligence platform at Sun Yat-sen University Cancer Center (SYSUCC), that we introduced previously [19]. Totally, 7251 patients with newly diagnosed, non-disseminated, pathologically proven NPC undergoing IMRT-based strategies between April 2009 and December 2014 were identified; those with other malignancies, or incomplete sociodemographic and/or clinicopathologic data were excluded.…”