Hepatitis B virus infection specially increases risk of liver metastasis in breast cancer patients: a propensity-matched analysis
TRANSLATIONAL CANCER RESEARCH
Authors: Yu, Ping; Liu, Peng; Li, Na; Xie, Xinhua; Tang, Hailin; Wu, Jiali; Kong, Yanan; Xie, Xiaoming; Ye, Feng
Abstract
Background: Breast cancer and hepatitis B virus (HBV) infection are serious public health issues in China. But the effect of HBV infection on breast cancer remains unclear. The objective was to assess whether HBV infection was associated with prognosis of breast cancer. Methods: A retrospective database of 1,924 invasive breast cancer patients from Sun Yat-sen University Cancer Center from 2008 to 2010 was established. Propensity score matching method was applied to balance baseline parameters. Logistic regression was used for identifying the independent risk factors of liver metastasis. Prognostic outcomes were evaluated via Kaplan-Meier analysis and Cox model. Results: Primary evaluation of gross data suggested HBV infection was associated with much higher rate of liver metastasis. 642 patients were matched for analysis. The median follow-up time was about 69 months. Patients with HBV surface antigen (HBsAg) (+) had a specially higher risk of liver metastasis aside of other distant organs than those with HBsAg (-). HBsAg (-/+) was identified to be an independent risk factor of liver metastasis [odds ratio (OR), 2.651; 95% confidence intervals (CI), 1.213- 5.796; P=0.015]. HBsAg (+) was associated with liver metastasis significantly in stage III or in estrogen receptor (ER) (+) and/or progesterone receptor (PR) (+), human epidermal growth factor receptor-2 (HER-2) (-) subtype. Meanwhile, patients with HBsAg (+) had significant shorter liver metastasis-free survival (LMFS) compared with HBsAg (-) patients (P=0.041). But the difference of overall survival (OS) between the HBsAg (-) and HBsAg (+) groups reached statistically no significance (P=0.425).The multivariate analysis suggested HBsAg (+) could worsen the outcome of LMFS [hazards ratio (HR), 2.450; 95% CI, 1.169-5.135; P=0.018]. Conclusions: In breast cancer, HBsAg (+) was associated with specially a higher rate of liver metastasis and thus worsened the LMFS. HBsAg (-/+) was an independent risk factor of liver metastasis.
Incidence, Factors, and Patient-Level Data for Spontaneous HBsAg Seroclearance: A Cohort Study of 11,264 Patients
CLINICAL AND TRANSLATIONAL GASTROENTEROLOGY
Authors: Yeo, Yee Hui; Tseng, Tai-Chung; Hosaka, Tetsuya; Cunningham, Chris; Fung, James Yan Yue; Ho, Hsiu J.; Kwak, Min-Sun; Trinh, Huy N.; Ungtrakul, Teerapat; Yu, Ming-Lung; Kobayashi, Mariko; Le, An K.; Henry, Linda; Li, Jiayi; Zhang, Jian; Sriprayoon, Tassanee; Jeong, Donghak; Tanwandee, Tawesak; Gane, Ed; Cheung, Ramsey C.; Wu, Chun-Ying; Lok, Anna S.; Lee, Hyo-Suk; Suzuki, Fumitaka; Yuen, Man-Fung; Kao, Jia-Horng; Yang, Hwai-, I; Nguyen, Mindie H.
Abstract
INTRODUCTION: Spontaneous hepatitis B surface antigen (HBsAg) seroclearance, the functional cure of hepatitis B infection, occurs rarely. Prior original studies are limited by insufficient sample size and/or follow-up, and recent meta-analyses are limited by inclusion of only study-level data and lack of adjustment for confounders to investigate HBsAg seroclearance rates in most relevant subgroups. Using a cohort with detailed individual patient data, we estimated spontaneous HBsAg seroclearance rates through patient and virologic characteristics. METHODS: We analyzed 11,264 untreated patients with chronic hepatitis B with serial HBsAg data from 4 North American and 8 Asian Pacific centers, with 1,393 patients with HBsAg seroclearance (>= 2 undetectable HBsAg >= 6 months apart) during 106,192 person-years. The annual seroclearance rate with detailed categorization by infection phase, further stratified by hepatitis B e antigen (HBeAg) status, sex, age, and quantitative HBsAg (qHBsAg), was performed. RESULTS: The annual seroclearance rate was 1.31% (95% confidence interval: 1.25-1.38) and over 7% in immune inactive patients aged >= 55 years and with qHBsAg <100 IU/mL. The 5-, 10-, 15-, and 20-year cumulative rates were 4.74%, 10.72%, 18.80%, and 24.79%, respectively. On multivariable analysis, male (adjusted hazard ratio [aHR] = 1.66), older age (41-55 years: aHR = 1.16; >55 years: aHR = 1.21), negative HBeAg (aHR = 6.34), and genotype C (aHR = 1.82) predicted higher seroclearance rates, as did lower hepatitis B virus DNA and lower qHBsAg (P< 0.05 for all), and inactive carrier state. DISCUSSION: The spontaneous annual HBsAg seroclearance rate was 1.31%, but varied from close to zero to about 5% among most chronic hepatitis B subgroups, with older, male, HBeAg-negative, and genotype C patients with lower alanine aminotransferase and hepatitis B virus DNA, and qHBsAg independently associated with higher rates (see Visual Abstract, Supplementary Digital Content 2, http://links.lww.com/CTG/A367).