Effect Of Hepatitis B Virus Infection On The Prognosis Of Esophageal Squamous Cell Carcinoma

BackgroundsThere is a clear relationship between hepatitis B virus(HBV)infection and the occurrence and development of hepatocellular carcinoma(HCC),and HBV infection is also related to the prognosis of non-liver primary tumors.Non-liver primary tumor patients with HBV infection generally have a poor prognosis.In 2018,about 84 million people in my country were infected with HBV,and esophageal carcinoma also showed a high incidence in my country,ranking sixth in the incidence of all malignant tumors.In my country,esophageal squamous cell carcinoma(ESCC)is the main pathological type.Therefore,the number of esophageal cancer with HBV infection is not small.Because the clinical manifestations of early ESCC are not obvious and there is no sensitive and convenient early screening method,most of them are diagnosed as ESCC at a later stage,and the long-term survival rate is poor.There are many studies on its prognosis,but there are few studies on the effect of HBV infection on the prognosis of ESCC,and the reported results are completely opposite to other non-liver primary tumor prognosis.ObjectiveExplore the effect of hepatitis B virus on the prognosis of ESCC,further verify the independent prognostic factors of ESCC,and try to provide new ideas for exploring the occurrence and development of ESCC.MethodsThis retrospective cohort study selected patients who underwent radical resection of esophageal squamous cell carcinoma from January 2016 to December 2017 in Nanfang Hospital,Southern Medical University.The pathological staging is strictly based on the UICC/AJCC 8th edition TNM staging of esophageal carcinoma.Use electrochemiluminescence or ELISA to detect serum HBV markers.Patients were divided into Hepatitis B Surface Antigen(HBsAg)-positive group(HBV infection)and HBsAg-negative group.Propensity score matching(PSM)was used to control the differences between groups of confounding variables.The Kaplan-Meier method was used to evaluate the overall survival of ESCC patients with HBV infection.The impact of overall survival(OS)was analyzed by Kaplan-Meier method and Log-Rank test for univariate analysis,and COX proportional hazard regression model was used for multivariate analysis to study independent prognostic factors.ResultsA total of 203 cases were included,of which 50 were HBsAg-positive cases(24.6%).The average OS of the two groups was about 38.4 months,and the median OS was about 42.0 months.The remaining 88 cases were matched by PSM,of which 44 were HBsAg-positive cases(50.0%).The average OS of the two groups was about 33.6 months,and the median OS was about 32.0 months.The average OS of patients in the HBsAg-positive group was about 41.4 months,which has not yet reached the median OS;the patients in the negative group had an average OS of about 23.5 months,and the median OS was 22.0 months,p=0.002.The difference between the two groups was statistically significant.The average OS of the patients in the HBsAg-positive group was better than that of the patients in the negative group.Excluding the preoperative neoadjuvant treatment cases,79 cases remained,of which 40 cases were HBsAg positive(50.6%).The average OS of the two groups was about 34.3 months,and the median OS was about 33.0 months.The average OS of patients in the HBsAg-positive group was 40.5 months,which has not yet reached the median OS;the average OS of the patients in the negative group was 25.3 months,and the median OS was 22.0 months,p=0.020.The difference between the two groups was statistically significant.The average OS of patients in the HBsAg-positive group was better than that in the negative group.Univariate analysis showed that age(p=0.005),postoperative pathological stage(p=0.001),and HBV infection(p=0.002)were the prognostic factors of ESCC.Multivariate analysis of these three factors showed that age,postoperative pathological staging,and HBV infection are independent prognostic factors for ESCC.Patients older than or equal to 61 years of age have worse average OS than patients younger than 61 years of age(HR=1.623,95%confidence interval(CI):1.184-2.225,p=0.003);Patients with postoperative pathological stages of stage Ⅱ and Ⅲ-Ⅳ had worse average OS than patients with stage 0-Ⅰ(p=0.001),but the difference in average OS between stage Ⅱ and Ⅲ-Ⅳpatients was not statistically significant(p=0.296);patients in the HBsAg positive group had better average OS than those in the negative group(HR=0.408,95%CI:0.216-0.769,p=0.006).ConclusionsHepatitis B virus infection may be a potential protective factor for the prognosis of esophageal squamous cell carcinoma after radical resection.Age greater than or equal to 61 years and postoperative pathological stage Ⅱ-Ⅳ may be poor prognostic factors after radical resection of esophageal squamous cell carcinoma.