Hepatitis B is associated with various cancersEveryone knows the close relationship between HBV and HCC, human papilloma virus and cervical cancer.

Infectious pathogens not only cause chronic inflammation but also cause tumorigenesis in target organs. HBV can cause HCC. On the other hand, a positive association between HBsAg-positive HBV infection and B-cell non-Hodgkin lymphomas (NHLs) has been demonstrated in many case-control studies or cohort studies and meta-analyses, which occurs in HBsAg-positive patients. The risk of B-cell NHL is 2 to 3 times higher than in uninfected patients.

A recent meta-analysis including 58 studies with a total of 53,714 NHL cases and more than 1.7 million controls demonstrated a positive association between HBV infection and B cell NHL development. HBV infection is also significantly associated with diffuse large B-cell lymphoma (DLBCL).

Countries with higher HBV prevalence have been reported to have increased odds of developing DLBCL. Many studies have also focused on the impact of HBV infection on the clinical status of DLBCL patients.

However, the results are inconsistent in different studies, especially in the clinical characteristics of patients with DLBCL treated with rituximab.

Hepatitis B antigen positivity may be related to lymphomaResearchers from Taiwan conducted a retrospective analysis to investigate the clinical features and prognostic effects of HBV infection in newly diagnosed DLBCL patients.

This retrospective cohort study investigated the clinical correlates of HBsAg in patients with DLBCL treated with rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone between 2002 and 2016.

The results showed that of the 416 patients analyzed, 98 (23.6%) were HBsAg positive. HBsAg positivity was associated with younger age, more malignant disease at diagnosis, more frequent liver damage, and a trend towards higher Cancer Prognostic Index (NCCN-IPI) score at diagnosis.

Compared with HBsAg-negative patients, HBsAg-positive patients showed lower overall response rate, worse five-year overall survival (OS) and shorter 5-year progression-free survival (PFS).

Multivariate analysis showed that HBsAg positivity was an independent adverse prognostic indicator for OS and PFS. A scoring system combining HBsAg positivity, NCCN-IPI score, and serum albumin levels demonstrated that this indicator is useful in stratifying prognostic relevant subgroups of DLBCL patients.

Through this result, the researchers believe that HBV infection has a unique relationship with DLBCL. For such patients, HBsAg may be a new biomarker.

In this large retrospective cohort study from an area with high HBV infection rates, the authors demonstrate that HBsAg is an independent adverse factor significantly associated with survival in patients with DLBCL, highlighting its potential as a novel prognostic indicator in clinical practice. The application may improve the clinical management of DLBCL patients and help reduce their risk earlier.