Clinical correlation and survival analysis of hepatitis B virus infection in oral squamous cell carcinoma: a retrospective study of 1373 patients

Abstract

Background: Chronic hepatitis B virus (HBV) infection poses a significant global public health challenge and is found closely related to extrahepatic cancers, including head and neck cancer. Oral squamous cell carcinoma (OSCC) is the major category of head and neck cancer. This retrospective study was conducted to explore the clinical correlation and survival analysis of OSCC patients with HBV.

Methods: The study involved 1,373 patients with OSCC treated at the Hospital of Stomatology, Sun Yat-sen University from 2012 to 2022. Propensity score matching was used to analyze the clinical correlations and survival outcomes, specifically overall survival (OS) and disease-free survival (DFS), in patients with or without hepatitis B surface antigen (HBsAg) seropositivity. Subgroup analyses were conducted for both the early and advanced stages of OSCC. The benefits of neck dissection in OSCC patients with HBV infection were further investigated.

Results: The prevalence of HBV infection in our cohort was 12.0%. The HBsAg (+) group had a higher percentage of individuals under 60 (73.3% versus 63.7%, p = 0.016). Post-matching for age, sex, pathological T category, pathological N category, and neck dissection, the OSCC patients with HBsAg (+) had lower 5-year OS and DFS rates rather than HBsAg (-) patients, especially those with advanced stage and cervical lymph node metastasis. HBsAg (-) was confirmed as an independent protective prognostic indicator for both OS (hazard ratio [HR] = 0.52; 95% confidence interval [CI] = 0.34-0.79; p = 0.002) and DFS (HR = 0.69, 95% CI = 0.50-0.96; p = 0.027). Notably, elective neck dissection was recognized as an independent protective factor influencing 5-year OS and DFS. While DOI and pathological N category were both confirmed as the risk factors for prognosis.

Conclusions: HBsAg is a potential prognostic marker for OSCC. It is essential to screen for HBV infection prior to initiating tumor treatment. Additionally, serological testing, antiviral prophylaxis and therapy play crucial roles in preventing HBV reactivation during the course of tumor treatment. In cases of early OSCC associated with HBV infection, elective neck dissection has been shown to reduce the rates of recurrence and metastasis significantly.

Keywords: Head and neck cancer; Hepatitis B virus; Neck dissection; Oral squamous cell carcinoma; Propensity score matching.

Fig. 1

The workflow of the study

Fig. 2

The survival analysis for OSCC patients. The Kaplan-Meier (K-M) survival analysis among infected patients (HBsAg [+] + HBcAb [+]), past infected patients (HBsAg [−] + HBcAb [+]), and uninfected patients (HBsAg [−] + HBcAb [−]) (A, B). The K-M survival analysis between HBsAg (+) and HBsAg (−) patients (C, D). The K-M survival analysis between HBcAb (+) and HBcAb (−) patients (E, F)

Fig. 3

The survival analysis for propensity score matching analysis and subgroup analysis. The Kaplan-Meier (K-M) survival analysis between HBsAg (+) and HBsAg (−) patients by using the propensity score matching method (A, B). The K-M survival analysis in advanced-stage OSCC patients with and without HBV infection (C, D). The K-M survival analysis in OSCC patients with cervical lymph node metastasis between HBsAg (+) and HBsAg (−) group (E, F). The impact of neck dissection in early-stage OSCC patients with and without HBV infection (G, H). The Kaplan-Meier (K-M) survival analysis in HBsAg (+), HBcAb (+) patients with or without neck dissection (I, J). The Kaplan-Meier (K-M) survival analysis in HBsAg (−), HBcAb (+) patients with or without neck dissection (K, L)