Background:Breast cancer patients with hepatitis B virus (HBV) infection or past HBV infection face heightened risks of chemotherapy-induced hepatotoxicity and HBV reactivation (HBVr). This study aims to evaluate the impact of different HBV serological statuses on the safety of chemotherapy regimens based on paclitaxel throughout the treatment cycle.Methods:This retrospective cohort study analyzed 4562 female breast cancer patients, categorized into three groups: 366 with HBV infection (HBsAg+), 2529 with past HBV infection (HBsAg−/HBcAb+), and 1667 without HBV infection (control group). The Primary events included liver injury, HBVr, treatment interruption, and laboratory indicator evaluation. Demographic characteristics and periodic laboratory parameters were recorded for within-subject longitudinal analysis.Results:Before chemotherapy, the incidence of liver injury was highest in the HBV-infected group (18.2%), intermediate in the past-infection group (13.2%), and lowest in the control group (12.0%). Throughout chemotherapy, the cumulative incidence of liver injury remained highest in the HBV-infected group (83.2%), compared to the past-infection (71.2%) and control (70.9%) groups. Chemotherapy interruption rates followed a similar gradient: 12.4% in the HBV-infected group, 6.9% in the past-infection group, and 5.5% in the control group. HBV-infected patients had a significantly higher risk of hepatotoxicity than controls during cycle 4 (relative risk 1.56, 95% CI 1.06 to 2.29) and cycle 5 (1.28, 1.09 to 1.75). HBVr occurred in 13 patients with HBV-infected.Conclusions:HBV serological status significantly impacts chemotherapy safety and treatment interruption. Prophylactic antiviral therapy and intensified monitoring during high-risk cycles (cycle 4 and cycle 5) are critical. These findings underscore the necessity of stratified management for HBV-affected breast cancer patients during chemotherapy.
背景：合并乙型肝炎病毒（HBV）感染或既往有HBV感染的乳腺癌患者，面临化疗相关肝毒性与HBV再激活（HBVr）风险增加的问题。本研究旨在评估不同HBV血清学状态对基于紫杉醇的化疗方案在整个治疗周期内安全性的影响。 方法：本回顾性队列研究纳入4562例女性乳腺癌患者，分为三组：HBV感染组（HBsAg+，366例）、既往HBV感染组（HBsAg−/HBcAb+，2529例）及无HBV感染对照组（1667例）。主要观察指标包括肝损伤、HBVr、治疗中断及实验室指标评估。记录人口学特征及周期性实验室参数，并进行个体内纵向分析。 结果：化疗前，HBV感染组肝损伤发生率最高（18.2%），既往感染组次之（13.2%），对照组最低（12.0%）。整个化疗期间，HBV感染组肝损伤累积发生率最高（83.2%），高于既往感染组（71.2%）和对照组（70.9%）。化疗中断率呈现相似梯度：HBV感染组为12.4%，既往感染组为6.9%，对照组为5.5%。在第4周期（相对风险1.56，95% CI 1.06-2.29）和第5周期（1.28，1.09-1.75），HBV感染患者发生肝毒性的风险显著高于对照组。13例HBV感染患者发生HBVr。 结论：HBV血清学状态显著影响化疗安全性与治疗中断率。在高风险周期（第4、5周期）进行预防性抗病毒治疗并加强监测至关重要。这些发现强调了在化疗期间对合并HBV感染的乳腺癌患者实施分层管理的必要性。
肿瘤(癌症)患者之家