Zou Xiaofang, Guo Longhua, Gu Yinfang, Yang Zhijun, Huang Ping, Liu Tianhuang, Zhao Jingjing, Wu Guowu
Department of Medical Oncology, Cancer Center, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China.
Department of Hepatopathy, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China.
J Cancer. 2020 Mar 15;11(12):3559-3566. doi: 10.7150/jca.40154. eCollection 2020.
: Hepatitis B virus (HBV) reactivation may occur with chemotherapy and/or immunotherapy. Antiviral prophylaxis is recommended for all patients who are hepatitis B surface antigen (HBsAg)-positive during chemotherapy and/or immunosuppressive therapy. However, the optimal timing of antiviral therapy before chemotherapy and/or immunosuppressive therapy is not fully elucidated. : We retrospectively evaluated 446 HBsAg-positive patients who underwent chemotherapy and/or immunosuppressive therapy. The cumulative rates of HBV reactivation were evaluated using the Kaplan-Meier method and were compared using the log-rank test. The risk factors of HBV reactivation were examined via univariate and multivariate analyses using the Cox proportional hazards model. : The cumulative HBV reactivation rates of patients who received antiviral therapy before chemotherapy and/or immunosuppressive therapy were significantly lower than those of patients who received antiviral therapy after chemotherapy and/or immunosuppressive therapy ( = 0.002). The incidence of HBV reactivation was significantly different between patients who received antiviral therapy at least 1 day before chemotherapy and/or immunosuppressive therapy and those who did not ( = 0.006). No significant difference was observed in the HBV reactivation rates between patients who received antiviral therapy at least 2 days ( = 0.310), 3 days ( = 0.494), and 1 week ( = 0.655) before chemotherapy and/or immunosuppressive therapy and those who did not. The multivariate Cox proportional hazards model showed that women had a lower risk of developing HBV reactivation than men ( = 0.025). The use of the prophylactic antiviral agent entecavir, compared with lamivudine and telbivudine, was associated with the decreased risk of developing HBV reactivation ( = 0.002). : HBsAg-positive patients who received preemptive antiviral therapy after chemotherapy and/or immunosuppressive therapy had a high risk of developing HBV reactivation. However, it is not necessary for patients to receive antiviral therapy at least 1 week before chemotherapy and/or immunosuppressive therapy.
乙肝病毒（HBV）再激活可能发生于化疗和/或免疫治疗期间。对于所有在化疗和/或免疫抑制治疗期间乙肝表面抗原（HBsAg）阳性的患者，建议进行抗病毒预防。然而，化疗和/或免疫抑制治疗前抗病毒治疗的最佳时机尚未完全阐明。我们回顾性评估了446例接受化疗和/或免疫抑制治疗的HBsAg阳性患者。采用Kaplan-Meier法评估HBV再激活的累积发生率，并使用对数秩检验进行比较。通过使用Cox比例风险模型的单因素和多因素分析来检查HBV再激活的危险因素。在化疗和/或免疫抑制治疗前接受抗病毒治疗的患者的HBV再激活累积发生率显著低于在化疗和/或免疫抑制治疗后接受抗病毒治疗的患者（P = 0.002）。在化疗和/或免疫抑制治疗前至少1天接受抗病毒治疗的患者与未接受抗病毒治疗的患者之间，HBV再激活的发生率有显著差异（P = 0.006）。在化疗和/或免疫抑制治疗前至少2天（P = 0.310）、3天（P = 0.494）和1周（P = 0.655）接受抗病毒治疗的患者与未接受抗病毒治疗的患者之间，HBV再激活率未观察到显著差异。多因素Cox比例风险模型显示，女性发生HBV再激活的风险低于男性（P = 0.025）。与拉米夫定和替比夫定相比，使用预防性抗病毒药物恩替卡韦与发生HBV再激活的风险降低相关（P = 0.002）。在化疗和/或免疫抑制治疗后接受抢先抗病毒治疗的HBsAg阳性患者发生HBV再激活的风险较高。然而，患者没有必要在化疗和/或免疫抑制治疗前至少1周接受抗病毒治疗。
