International journal of clinical oncology · 2026
Prevention of hepatitis B virus reactivation according to hepatitis B surface antigen status in patients receiving systemic chemotherapy in Japan using an electronic medical record database.
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Hattori Masakatsu, Mizuno Kayoko, Honda Munenori, Yoshida Satomi, Kawakami Koji
Аннотация
BACKGROUND: Hepatitis B virus (HBV) reactivation is a critical complication in patients receiving systemic chemotherapy. While current guidelines recommend screening, whether appropriate preventive measures are implemented based on screening results remains unclear. This study aimed to evaluate the implementation of HBV screening and subsequent preventive measures according to hepatitis B surface antigen (HBsAg) status in patients undergoing chemotherapy in Japan.
METHODS: This retrospective cohort study utilized Japan's largest electronic medical record database to evaluate HBV management in adults (≥ 20 years) who initiated anticancer therapy between 2006 and 2020. Patients with prior HBV treatment were excluded. We assessed the implementation proportions of key steps in HBV management, including initial HBsAg screening, subsequent antibody and DNA testing based on results, and prophylactic antiviral therapy initiation.
RESULTS: Of 162,040 eligible patients, 93,801 (57.9%) underwent HBV screening. Among HBsAg-negative patients, only 29.4% received subsequent hepatitis B core antibody (anti-HBc) and hepatitis B surface antibody (anti-HBs) testing. HBV DNA testing was performed in 56.0% of patients positive for anti-HBc or anti-HBs. Only 18.3% of HBsAg-positive patients eligible for prophylaxis received nucleoside analogs. Screening and prophylaxis proportions improved over time, with the proportion receiving prophylactic administration reaching 27.1% in 2020. Screening was most frequent in patients with hematologic malignancies (58.3%) and in those receiving anti-CD20 antibodies (65.6%).
CONCLUSION: Despite suboptimal initial HBV screening proportions in Japan, a substantial gap remains in implementing subsequent preventive measures, particularly prophylactic therapy for HBsAg-positive patients. This highlights the critical need to improve adherence to guidelines to prevent HBV reactivation.
METHODS: This retrospective cohort study utilized Japan's largest electronic medical record database to evaluate HBV management in adults (≥ 20 years) who initiated anticancer therapy between 2006 and 2020. Patients with prior HBV treatment were excluded. We assessed the implementation proportions of key steps in HBV management, including initial HBsAg screening, subsequent antibody and DNA testing based on results, and prophylactic antiviral therapy initiation.
RESULTS: Of 162,040 eligible patients, 93,801 (57.9%) underwent HBV screening. Among HBsAg-negative patients, only 29.4% received subsequent hepatitis B core antibody (anti-HBc) and hepatitis B surface antibody (anti-HBs) testing. HBV DNA testing was performed in 56.0% of patients positive for anti-HBc or anti-HBs. Only 18.3% of HBsAg-positive patients eligible for prophylaxis received nucleoside analogs. Screening and prophylaxis proportions improved over time, with the proportion receiving prophylactic administration reaching 27.1% in 2020. Screening was most frequent in patients with hematologic malignancies (58.3%) and in those receiving anti-CD20 antibodies (65.6%).
CONCLUSION: Despite suboptimal initial HBV screening proportions in Japan, a substantial gap remains in implementing subsequent preventive measures, particularly prophylactic therapy for HBsAg-positive patients. This highlights the critical need to improve adherence to guidelines to prevent HBV reactivation.