Prognostic value of chronic hepatitis B virus infection in patients with nasopharyngeal carcinoma: Analysis of 1301 patients from an endemic area in China

Abstract

BACKGROUND:The current study investigated the prevalence and prognostic value of chronic hepatitis B virus (HBV) infection in patients with nasopharyngeal carcinoma (NPC) from an area in southern China in which HBV and NPC are endemic. METHODS: A total of 1301 patients with nonmetastatic, histologically proven NPC who were treated with radiotherapy or chemoradiotherapy were retrospectively reviewed. RESULTS: In this series, 142 of the 1301 patients (10.9%) had chronic HBV infection (hepatitis B surface antigen [HBsAg] seropositive). The percentages of non-cancer-related deaths (15.0% vs 12.1%; P 5.618) and severe hepatic adverse events (3.5% vs 0.9%; P 5.145) were similar among patients with NPC with and without HBV infection. The 5-year overall survival (OS), progression-free survival (PFS), and locoregional recurrence-free survival (LRFS) rates for patients with NPC with or without HBV infection were 70.9% and 80.8% (P 5.003), 63.7% and 73.0% (P 5.016), and 81.7% and 88.2% (P 5.035), respectively. Multivariate analysis identified chronic HBV infection in patients with NPC as an independent unfavorable prognostic factor for OS (hazards ratio [HR], 1.684; P 5.003), PFS (HR, 1.451; P 5.015), and LRFS (HR, 1.573; P 5.048). Further analysis revealed that chronic HBV infection was an unfavorable, independent prognostic factor in patients with locoregionally advanced NPC, but not those with early-stage disease. In patients with stage III=IV NPC, HBsAg-positive patients had poorer OS (64.0% vs 77.2%; P 5.003), PFS (56.2% vs 70.6%; P 5.004), and LRFS (76.2% vs 88.3%; P 5.002) compared with HBsAg-negative patients. On multivariate analysis, chronic HBV infection was found to be an independent adverse prognostic predictor for OS (HR, 1.734; P 5.004), PFS (HR, 1.644; P 5.003), and LRFS (HR, 2.108; P 5.003) in patients with stage III=IV NPC. CONCLUSIONS: Chronic HBV infection is an independent adverse prognostic factor in patients with locoregionally advanced NPC. Cancer 2014;120:68-76.

Clinical implications of hepatitis B viral infection in Epstein–Barr virus-associated nasopharyngeal carcinoma

“…The prevalence of HBsAg seropositivity in patients with NPC in this study was 10.9% (6), consistent with the recent report by Liu et al [19]. We also found that chronic HBV infection was more common in male patients and younger patients with NPC.…”

“…An initial large-scale study in the endemic area found that patients with NPC who were positive for hepatitis B surface antigen (HBsAg) had a poorer outcome than HBsAg(−) patients, especially in stage III-IV disease [19]. However, some important virological parameters such as EBV DNA load and HBV DNA load were not assessed and the association between EBV and HBV was not explored.…”

Comorbidity predicts poor prognosis in nasopharyngeal carcinoma: Development and validation of a predictive score model

“…Secondly, an increase in the severity of comorbidities may increase the toxicity of specific treatments, which may consequently shorten the survival period to the extent of canceling out any possible gain obtained from the therapy [16,31,32]. Furthermore, the most frequently observed comorbidity was HBV infection-associated liver disease, which is similar to the finding of a previous study in which HBV infectionassociated liver disease was reported to negatively affect cancerspecific survival [33]. The latent mechanism responsible for the unfavourable prognosis of HBV-infected patients with NPC may be linked to certain types of immunological dysfunction, as HBV is associated with immune dysfunction, as demonstrated by hepatitis B-related nephritis and its association with lymphoma [34,35].…”

A Multi-Parametric Prognostic Model Based on Clinical Features and Serological Markers Predicts Overall Survival in Non-Small Cell Lung Cancer Patients with Chronic Hepatitis B Viral Infection

“…Therefore, it is reasonable to speculate that chronic HBV infection may be an important comorbidity in patients with NSCLC in China. Previous studies found that HBV has been associated with some extra-hepatic cancers (Engels et al 2010;Liu et al 2014;Song et al 2019), and some cancers such as diffuse large B-cell lymphoma (Wang et al 2008) and multiple myeloma (Teng et al 2011) patients with HBV infection have poor survival outcomes compared to the non-infected patients. These results implied that NSCLC with HBV-infected patients should be distinguished from those uninfected patients because they have different clinical characteristics, outcomes and prognostic factors, which need to develop a distinct prognostic predictive model for the NSCLC with HBV-infected patients.…”