Effect of concomitant positive HBsAg on the risk of liver metastasis: a retrospective clinical study of 4033 consecutive cases of newly diagnosed colorectal cancer

Abstract

Aims

To evaluate the effect of chronic hepatitis B infection on the risk of synchronous colorectal liver metastasis (synCRLM).

Methods

A total of 4033 consecutive, newly diagnosed colorectal cancer (CRC) patients with hepatitis B test were enrolled. The prevalence of synCRLM was compared between hepatitis B surface antigen (HBsAg) positive and negative patients; significant predictors for synCRLM were analyzed by logistic regression analysis; a fibrosis index based on the four factors (FIB-4), an aspartate aminotransferase-to-platelet ratio index (APRI) and hepatitis B e antigen (HBeAg) status were compared between patients with or without synCRLM.

Results

The prevalence of synCRLM was significantly higher in the HBsAg⁺ patients than that in the HBsAg^- patients (15.57% vs. 8.60%, P<0.001, χ² test). A logistic regression analysis indicated that HBsAg⁺ showed the highest hazard ratio (HR, 2.317; 95% CI: 1.406-3.820) for synCRLM. Both FIB-4 and APRI were significantly higher in those with HBsAg⁺ but no synCRLM compared to those with HBsAg⁺ and synCRLM [FIB-4: 1.23 (0.92-1.88) vs. 1.09 (0.74~1.51), P=0.045; APRI: 0.23 (0.227~0.387) vs. 0.18 (0.171~0.309), P=0.023; median (P₂₅~P₇₅), Mann-Whitney test]; HBeAg positivity was detected in 26.32% of those with positive HBsAg and synCRLM compared to 18.45% of those with positive HBsAg but no synCRLM, the difference was not statistically significant.

Conclusions

Concomitant chronic HBV infection significantly increases the risk of CRLM, and for HBsAg ⁺ CRC patients, elevated FIB-4/APRI may be anti-metastatic. Further study is needed to determine whether active HBV replication is pro-metastatic.