Active chronic hepatitis B increases the risk of liver metastasis of colorectal cancer: A retrospective clinical study of 7187 consecutive cases of newly diagnosed colorectal cancer

Background The effect of concomitant chronic hepatitis B (CHB) infection on the risk of colorectal liver metastasis (CRLM) has not been definitively elucidated. Many clinicians believe that CHB is “protective” and although previous reports support their presumption, these studies were limited by small sample size, mixed types of chronic hepatitis and heterogeneous therapies. Methods To explore this issue, we retrospectively studied 7187 newly diagnosed colorectal cancer (CRC) patients. The definitions and diagnostic procedures of synchronous CRLM (synCRLM) were as per our previous report. Results The prevalence of HBsAg+ was 5.12% (364/7111) and HBeAg+ was 1.25% (76/6075). The overall prevalence of synCRLM was 8.72% (627/7187) and was significantly higher in HBsAg+ patients than HBsAg- patients (13.40% vs. 8.54%, P = 0.031). SynCRLM was also more prevalent in HBeAg+ patients compared to HBeAg- patients (19.70% vs. 10.17%, P = 0.031). In univariate logistic regression analysis, HBeAg+ had the highest hazard ratio (HR) [2.947, P Conclusions This study focuses only on the newly diagnosed synCRLM and eliminates the effect of various adjuvant and neoadjuvant therapy. In our previous study of 4033 CRC patients and contrary to much of the reported literature, HBsAg+ was associated with significantly increased prevalence of CRLM. HBeAg+ also trended toward increased CRLM prevalence but didn’t reach statistical significance. When expanded to 7187 subjects, HBeAg+ is finally proved to be a predictor of CRLM, with a HR much higher than that of HBsAg+. Unlike the minimal chance of HBsAg loss, HBeAg seroconversion and HBV-DNA repression can be achieved in many CHB patients with current anti-viral therapies. In summary, HBeAg+ is a clinical risk factor for CRLM that can be readily identified and addressed. Whether antiviral treatment can decrease the risk of CRLM is definitely worth further study. Legal entity responsible for the study The authors. Funding National Natural Science Fund of China (No.81872400). Disclosure L. Zhao: Speaker Bureau / Expert testimony: Bayer; Speaker Bureau / Expert testimony: MSD. J. Cao: Speaker Bureau / Expert testimony: Bayer. All other authors have declared no conflicts of interest.