Abstract
Purpose
Studies have reported a positive association between hepatitis B surface antigen (HBsAg)-positive hepatitis B virus (HBV) infection and follicular lymphoma (FL). Nevertheless, clinical information concerning chronic HBV infection in FL is sparse.
Methods
This retrospective cohort study investigated the prognostic impact of HBsAg in immunocompetent patients with FL treated with frontline rituximab-containing chemoimmunotherapy in an HBV-endemic area between 2006 and 2016.
Results
Among the 149 analyzed patients, 32 (21.5%) were HBsAg-positive. HBsAg positivity was positively associated with symptomatic splenomegaly, significant serous effusions, and peritreatment hepatic dysfunction. HBsAg-positive patients had a trend of lower complete remission rate (59.4% vs. 76.9%, P = 0.07), significantly poorer overall survival (hazard ratio for death, 2.68; 95% confidence interval, 1.21–5.92), and shorter progression-free survival than had HBsAg-negative patients. Multivariate analysis revealed that HBsAg is an independent adverse prognostic factor for overall survival. Intriguingly, HBsAg-positive patients had a higher incidence of progression of disease within 24 months (POD24) than had HBsAg-negative patients (cumulative incidence rate, 25.8% vs. 12.4%, P = 0.045).
Conclusion
This study revealed that patients with FL and chronic HBV infection represent a distinct subgroup with a markedly poor prognosis. HBsAg was positively associated with POD24 and might serve as a new prognostic predictor of the survival of FL patients in endemic regions for HBV infection.
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Availability of data and materials
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Code availability
IBM SPSS Statistics (version21, software; IBM, Armonk, NY, USA).
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We thank the relevant medical staff and patients for their contributions to this study.
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This work was sponsored by grants from the Ministry of Science and Technology, Taiwan (108-2314-B-002-074 and 109-2314-B-002-276) and the Department of Medical Research, National Taiwan University Cancer Center (NTUCCS-109-10).
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C.L.C. designed the study, analyzed and interpreted data, performed statistical analysis, and wrote the manuscript. W.Q.F. performed the statistical analysis and wrote the manuscript. Y.J.L. collected and assembled the data. C.T.Y. participated in the pathologic review. B.S.K., J.L.T. and H.F.T. participated in the data collection and enrollment of patients.
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Cheng, CL., Fang, WQ., Lin, YJ. et al. Hepatitis B surface antigen positivity is associated with progression of disease within 24 months in follicular lymphoma. J Cancer Res Clin Oncol 148, 1211–1222 (2022). https://doi.org/10.1007/s00432-021-03719-y
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DOI: https://doi.org/10.1007/s00432-021-03719-y