Clinicopathological and Prognostic Features of Hepatitis B Virus-associated Diffuse Large B-cell Lymphoma: A Single-Center Retrospective Study in China

The main aim of our study was to retrospectively investigate the clinicopathological characteristics and prognosis factors of DLBCL patients with HBV infection in China. We collected 420 patients with DLBCL who were originally diagnosed and treated at Fujian Cancer Hospital, China. In our study, 127 (30.2%) patients were HBsAg-positive. HBsAg-positive DLBCL displayed a younger median onset age (50 vs. 54 years, P=0.002), more frequent involvement of the spleen (19.7% vs. 6.1% , P<0.001), less frequent involvement of the small and large intestine (2.3% vs 11.2%, P=0.003), more advanced disease (stage III/IV: 56.7% vs. 45.1%, P=0.028), and lower expression rate of MYC (49.1% vs. 66.7%, P=0.026). The median follow-up time was 61.9 months. Univariate analysis showed that there was no significant difference in overall survival (OS) between HBsAg-negative and -positive DLBCL (P=0.577). In the HBsAg-positive DLBCL subgroup, age older than 60 years, advanced disease, elevated lactate dehydrogenase (LDH), spleen involvement, B symptoms (fever, night sweats, weight loss), and double expressers of MYC and BCL2 had a significantly worse outcome, and patients treated with R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) had a better prognosis. Multivariate analysis further confirmed that spleen involvement and rituximab use were independent prognostic factors in HBsAg-positive DLBCL patients. Our study indicates that HBsAg-positive DLBCL has unique clinicopathological features and independent prognostic factors. Moreover, HBV infection does not appear to affect the prognosis of DLBCL patients, and the use of rituximab significantly improves OS in HBsAg-positive DLBCL patients.