Prognostic Value of Chronic Hepatitis B Virus Infection in Patients With Nasopharyngeal Carcinoma

BACKGROUNDThe 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. METHODSA total of 1301 patients with nonmetastatic, histologically proven NPC who were treated with radiotherapy or chemoradiotherapy were retrospectively reviewed. RESULTSIn 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=.618) and severe hepatic adverse events (3.5% vs 0.9%; P=.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=.003), 63.7% and 73.0% (P=.016), and 81.7% and 88.2% (P=.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=.003), PFS (HR, 1.451; P=.015), and LRFS (HR, 1.573; P=.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=.003), PFS (56.2% vs 70.6%; P=.004), and LRFS (76.2% vs 88.3%; P=.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=.004), PFS (HR, 1.644; P=.003), and LRFS (HR, 2.108; P=.003) in patients with stage III/IV NPC. CONCLUSIONSChronic HBV infection is an independent adverse prognostic factor in patients with locoregionally advanced NPC. Cancer 2014;120:68-76. (c) 2013 American Cancer Society. To the best of the authors' knowledge, the current study is the first large-scale study to determine the impact of chronic hepatitis B virus (HBV) infection on the prognosis of nasopharyngeal carcinoma (NPC) in a population with a high prevalence of chronic HBV infection and NPC. Chronic HBV infection represents a significant, unfavorable prognostic factor in patients with nonmetastatic, locoregionally advanced NPC.