Department of Medical Oncology, Centre for Biostatistics and Clinical Trials, and Department of Infectious Diseases, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Victoria, Australia.
J Oncol Pract. 2011 May;7(3):141-7. doi: 10.1200/JOP.2010.000133.
Universal screening for chronic hepatitis B virus (HBV) before chemotherapy has been recommended by the Centers for Disease Control. We sought to determine the practice of Australian oncologists with regard to HBV screening in patients with solid tumors (STs) and their clinical experience of HBV reactivation (HBVR).
A survey was sent to all consultant members of the Medical Oncology Group of Australia. One hundred eighty-eight responses (63% response rate) were received. We also reviewed the incidence of HBV in patients with STs screened at the Peter MacCallum Cancer Centre (Melbourne, Australia).
Fifty-three percent of medical oncologists screen for HBV, but only 19% screen all patients. The most common reasons given for performing screening were anecdotal experience of HBVR (46%) and perceived sufficient evidence for screening of some patient subgroups (42%). Sixty-five percent of those who screened did so only in subgroups, usually selecting patients on the basis of ethnicity (82%). Oncologists who did not screen most commonly cited inadequate evidence for a benefit of screening (72%). Twenty-two percent of oncologists had witnessed one or more HBVR events, representing one event per 45 years of respondents' practice. HBVR events reported (n = 54) consisted of asymptomatic liver test abnormalities only (44%), symptomatic hepatitis (28%), decompensated liver failure (19%), and death (7%). In 206 patients with STs screened for HBV, 1.0% (n = 2) were HBV surface antigen positive, and 14.9% hepatitis B core antibody positive.
The majority of Australian medical oncologists have not adopted universal HBV screening before chemotherapy. Further evidence of the benefit and cost effectiveness of universal screening in patients with STs will be required to alter practice.
美国疾病控制中心建议在化疗前对慢性乙型肝炎病毒（HBV）进行普遍筛查。我们旨在确定澳大利亚肿瘤学家在实体瘤（ST）患者中进行 HBV 筛查的实践情况及其对 HBV 再激活（HBVR）的临床经验。
向澳大利亚医学肿瘤学组的所有顾问成员发送了一份调查。收到了 188 份回复（63%的回复率）。我们还回顾了在澳大利亚墨尔本彼得·麦卡伦癌症中心（Peter MacCallum Cancer Centre）筛查的 ST 患者中 HBV 的发生率。
53%的肿瘤学家筛查 HBV，但只有 19%筛查所有患者。进行筛查的最常见原因是有 HBVR 的传闻经验（46%）和认为某些患者亚组筛查的证据充分（42%）。进行筛查的人中，65%仅在亚组中进行筛查，通常根据种族选择患者（82%）。大多数不进行筛查的肿瘤学家最常引用缺乏筛查获益的证据（72%）。22%的肿瘤学家目睹过一次或多次 HBVR 事件，每 45 年发生一次事件。报告的 HBVR 事件（n=54）仅包括无症状肝功能异常（44%）、症状性肝炎（28%）、肝功能失代偿（19%）和死亡（7%）。在筛查 HBV 的 206 例 ST 患者中，1.0%（n=2）为 HBV 表面抗原阳性，14.9%为乙型肝炎核心抗体阳性。
大多数澳大利亚肿瘤学家尚未采用化疗前普遍筛查 HBV。需要进一步证明 ST 患者普遍筛查的益处和成本效益，以改变实践。
