Abstract
In addition to hepatocellular carcinoma, chronic hepatitis B virus (HBV) infection has been reported to be associated with increased morbidity and mortality in other cancers. However, the impact of chronic HBV infection on the prognosis of breast cancer (BC) remains unknown. The aim of our study was to evaluate the prognostic value of HBV infection for BC in an endemic area of HBV in China. The study included a total of 1904 patients with early breast cancer who underwent mastectomy or breast conserving surgery. 212 patients (11.1%) were identified with chronic HBV infection due to serum hepatitis B surface antigen (HBsAg) positive. HBsAg-positive patients had inferior overall survival (OS) (84.9% vs. 90.4%, P = 0.005) and hepatic metastasis-free survival (HMFS) (92.5% vs. 97.1%, P=0.016) at five years than HBsAg-negative patients. Chronic HBV infection was an independent predictor of poor OS outcome in patients with BC (multivariate analysis; HR, 1.52; P = 0.038), but not for HMFS. Subgroup analysis showed that chronic HBV infection was an unfavorable independent prognostic factor for OS in patients with stage II/III BC (HR, 1.59; P = 0.025), with respective 5-year OS and HMFS rates of 81.9% and 90.5% compared with 88.5% and 96.3% in HBsAg-negative patients. In stage I patients, there was no significant difference in 5-year OS (95.8% vs 97.1%; P = 0.629) and HMFS (100% vs 99.0%; P = 0.447). In conclusion, chronic HBV infection predicts a worse prognosis in patients with stage II/III BC, but not stage I BC. Funding Statement: This work was supported by the National Natural Science Foundation of China (grant numbers 81672598, 81772961). Declaration of Interests: The authors state that there is no conflict of interest. Ethics Approval Statement: This study was approved by the Ethics Committee of the Sun Yat-sen University Cancer Center in accordance with the ethical principles of the Helsinki Declaration of the World Medical Association. The clinical staging was carried out in accordance with the 7th edition of the Tumor TNM Staging System developed by Union for International Cancer Control (UICC) and American Joint Committee on Cancer(AJCC) on Cancer Staging.
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