Association of hepatitis B virus DNA levels with overall survival for advanced hepatitis B virus-related hepatocellular carcinoma under immune checkpoint inhibitor therapy
Mengchao An # 1 , Wenkang Wang # 2 , Jie Zhang 3 , Brian G Till 4 , Lingdi Zhao 1 , Hao Huang 1 , Yonghao Yang 1 , Tiepeng Li 1 , Lu Han 1 , Xiaojie Zhang 1 , Peng Qin 1 , Yunjian Wang 5 , Min Zhang 5 , Hong Cui 5 , Quanli Gao 6 , Zibing Wang 7
Affiliations
Affiliations
1
Department of Immunotherapy, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.
2
Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
3
Department of Pathology, School of Basic Medical Sciences, Xinxiang Medical University, Xinxiang, China.
4
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, USA.
5
Department of Hepatobiliary Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.
6
Department of Immunotherapy, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China. [email protected].
7
Department of Immunotherapy, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China. [email protected].
#
Contributed equally.
PMID: 35907016 DOI: 10.1007/s00262-022-03254-w
Abstract
Background: High hepatitis B virus (HBV) DNA level is an independent risk factor for postoperative HBV-associated liver cancer recurrence. We sought to examine whether HBV DNA level and antiviral therapy are associated with survival outcomes in patients with advanced hepatocellular carcinoma (HCC) treated with anti-programmed cell death protein 1 (PD-1)based immunotherapy.
Methods: This single-institution retrospective analysis included 217 patients with advanced HBV-related HCC treated from 1 June 2018, through 30 December 2020. Baseline information was compared between patients with low and high HBV DNA levels. Overall survival (OS) and progression-free survival (PFS) were compared, and univariate and multivariate analyses were applied to identify potential risk factors for oncologic outcomes.
Results: The 217 patients included in the analysis had a median survival time of 20.6 months. Of these HBV-associated HCC patients, 165 had known baseline HBV DNA levels. Baseline HBV DNA level was not significantly associated with OS (P = 0.59) or PFS (P = 0.098). Compared to patients who did not receive antiviral therapy, patients who received antiviral therapy had significantly better OS (20.6 vs 11.1 months, P = 0.020), regardless of HBV DNA levels. Moreover, antiviral status (adjusted HR = 0.24, 95% CI 0.094-0.63, P = 0.004) was an independent protective factor for OS in a multivariate analysis of patients with HBV-related HCC.
Conclusions: HBV viral load does not compromise the clinical outcome of patients with HBV-related HCC treated with anti-PD-1-based immunotherapy. The use of antiviral therapy significantly improves survival time of HBV-related HCC patients.
Keywords: Hepatitis B virus; Hepatocellular carcinoma; Immunotherapy; Programmed cell death protein-1.