Background

Patients with hepatitis B virus (HBV) infection have a risk of reactivation after chemotherapy. All patients undergoing chemotherapy should be screened for HBV infection. No large-scale studies have been conducted to examine HBV screening practice in Japan.

Methods

We analyzed health insurance claims equivalent data linked with a nationwide hospital-based cancer registry. Patients diagnosed with cancer in 2014, who were aged 20 years and older and those who underwent systemic anticancer treatment in 2014–15 were included. We assessed the HBV screening rates by the HBsAg or anti-HBc tests, HBV-DNA tests, and entecavir prescriptions. Multiple logistic regression models were used to identify factors related to the receipt of screening.

Results

Of 177,597 patients (mean [SD] age, 65.6 [12.2] years), 82.6% and 12.9% patients had a solid tumor and hematologic malignancy, respectively. Among them, 88.1%, 6.3%, and 5.5% received cytotoxic chemotherapy, targeted therapy, and anti-CD20 antibodies, respectively. Overall, 70.6% of patients were screened. The positive predictor of HBV screening was receiving anti-CD20 antibodies [odds ratio (OR); 2.23, 95% confidence interval (CI) 2.06–2.41, p < 0.001] and negative predictors were age ≥ 85 (OR 0.76, 95% CI 0.71–0.81), age 75–84 (OR 0.77, 95% CI 0.75–0.79) and targeted therapy (OR 0.69, 95% CI 0.67–0.72). Among the screened patients, 13.2% were tested for HBV-DNA, and 1.49% were prescribed entecavir.

Conclusions

The HBV screening rate in Japan is higher than in other countries. Further improvement of the HBV screening rate is needed to prevent reactivation and avoidable deaths of patients with HBV infection.

中文翻译：

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日本接受全身抗癌治疗的患者乙肝病毒筛查率较高。

背景

乙型肝炎病毒（HBV）感染的患者在化疗后有重新激活的风险。所有接受化疗的患者均应筛查HBV感染。在日本尚未进行大规模的研究来检查HBV筛查方法。

方法

我们分析了与全国性基于医院的癌症注册中心相关联的健康保险理赔等效数据。纳入2014年被诊断患有癌症的患者，年龄在20岁及以上的患者以及2014-15年接受了全身抗癌治疗的患者。我们通过HBsAg或抗HBc检测，HBV-DNA检测和恩替卡韦处方评估了HBV筛查率。使用多个逻辑回归模型来确定与筛查接收有关的因素。

结果

在177,597名患者中（平均[SD]年龄，65.6 [12.2]岁），分别有82.6％和12.9％的患者患有实体瘤和血液系统恶性肿瘤。其中，分别有88.1％，6.3％和5.5％的患者接受了细胞毒性化疗，靶向治疗和抗CD20抗体。总体而言，筛查了70.6％的患者。HBV筛查的阳性预测指标是接受抗CD20抗体[比值比（OR）；2.23，95％置信区间（CI）2.06-2.41，p  <0.001]，阴性预测因子年龄≥85（OR 0.76，95％CI 0.71-0.81），年龄75-84（OR 0.77，95％CI 0.75-0.79） ）和靶向治疗（OR 0.69，95％CI 0.67–0.72）。在筛查的患者中，有13.2％的患者进行了HBV-DNA检测，而开处方的恩替卡韦为1.49％。

结论

日本的HBV筛查率高于其他国家。需要进一步提高HBV筛查率，以防止HBV感染患者重新激活并避免死亡。