目的:我们旨在探讨与病毒学和临床复发相关的危险因素,以及它们对总死亡率的影响,在乙型肝炎病毒(HBV)感染的患者接受核苷(t)类似物(NUCs)的化疗开始前治疗。
方法:从2010年到2020年,我们进行了一项前瞻性队列研究,涉及接受细胞毒性化疗的HBV感染患者。我们使用Kaplan-Meier方法和Cox比例风险回归模型来评估危险因素。
结果:我们观察到TDF或TAF(HR:2.16,95%CI1.06-4.41;p=.034),蒽环类药物(HR:1.73,95%CI1.10-2.73;p=0.018),基线HBVDNA(HR:1.55,95%CI1.33-1.81;p<.001)和治疗结束时HBsAg滴度>100IU/mL(HR:7.81,95%CI1.94-31.51;p=.004)与病毒学复发风险增加相关。此外,TDF或TAF(HR:4.91,95%CI1.45-16.64;p=.011),基线HBVDNA(HR:1.48,95%CI1.10-1.99;p=.009)和治疗结束时HBsAg滴度>100IU/mL(HR:6.09,95%CI.95-38.87;p=.056)与临床复发风险增加相关。此外,我们发现病毒学复发(HR:3.32,95%CI1.33-8.32;p=.010)和临床复发(HR:3.59,95%CI1.47-8.80;p=.005)与接受细胞毒性化疗和预防性NUC治疗的HBV患者的全因死亡率显著相关.
结论:病毒学和临床复发的风险与基线HBVDNA有关,治疗结束时的HBsAg水平和TDF或TAF用于预防;此外,经历复发会增加全因死亡的风险.需要进一步的研究来探索预防高危患者病毒学和临床复发的潜在策略。
OBJECTIVE: We aimed to explore the risk factors associated with virological and clinical relapse, as well as their impact on overall mortality, in hepatitis B virus (HBV)-infected patients receiving nucleos(t)ide analogues (NUCs) therapy prior to chemotherapy initiation.
METHODS: From 2010 to 2020, we conducted a prospective cohort study involving patients with HBV infection undergoing cytotoxic chemotherapy. We utilized the Kaplan-Meier method and Cox proportional hazard regression models to assess risk factors.
RESULTS: We observed that TDF or TAF (HR: 2.16, 95% CI 1.06-4.41; p = .034), anthracycline (HR: 1.73, 95% CI 1.10-2.73; p = .018), baseline HBV DNA (HR: 1.55, 95% CI 1.33-1.81; p < .001) and end-of-treatment HBsAg titre >100 IU/mL (HR: 7.81, 95% CI 1.94-31.51; p = .004) were associated with increased risk of virological relapse. Additionally, TDF or TAF (HR: 4.91, 95% CI 1.45-16.64; p = .011), baseline HBV DNA (HR: 1.48, 95% CI 1.10-1.99; p = .009) and end-of-treatment HBsAg titre >100 IU/mL (HR: 6.09, 95% CI .95-38.87; p = .056) were associated with increased risk of clinical relapse. Furthermore, we found that virological relapse (HR: 3.32, 95% CI 1.33-8.32; p = .010) and clinical relapse (HR: 3.59, 95% CI 1.47-8.80; p = .005) significantly correlated with all-cause mortality in HBV patients receiving cytotoxic chemotherapy with prophylactic NUCs therapy.
CONCLUSIONS: The risk of virological and clinical relapse was linked to baseline HBV DNA, end-of-treatment HBsAg levels and TDF or TAF for prophylaxis; additionally, experiencing relapse heightens the risk of all-cause mortality. Further research is warranted to explore potential strategies for preventing virological and clinical relapse in high-risk patients.