Low-level HBV viremia independently predicts poor outcomes in patients with intermediate-to-advanced HBV-related hepatocellular carcinoma receiving systemic therapy: a multicenter retrospective study

作者：Lei Jin, Huaxing Ma, Xiong Chen, Ling Lin, Zhipeng Liang, Guangling Ou, Jiliang Jin, Hongyuan Dai, Ya Zhang, Haiyang Li, Haiyang Li, Yinying Lu · 发表于：Therapeutic Advances in Medical Oncology · 年份：2026 · DOI：10.1177/17588359261435330 · 研究领域：Hepatitis B Virus Studies、Hepatocellular Carcinoma Treatment and Prognosis、Hepatitis C virus research

Background: Low-level hepatitis B viremia is recognized as a potential driver of hepatocarcinogenesis; however, its prognostic impact on patients with advanced hepatocellular carcinoma (HCC) receiving systemic therapy remains poorly defined. Objective: To determine the independent prognostic impact of low-level viremia (LLV; HBV DNA 20–2000 IU/mL) compared with maintained virologic response (MVR; HBV DNA < 20 IU/mL) in patients with intermediate-to-advanced HBV-related HCC undergoing systemic therapy, and to evaluate whether on-treatment viral status serves as a superior predictor to baseline HBV DNA levels. Design: This was a multicenter retrospective cohort study. Methods: A total of 1814 patients treated at three centers between 2020 and 2024 were retrospectively enrolled. After ⩾4 months of follow-up, patients were classified into LLV ( n = 860) or maintained virologic response (MVR; HBV DNA < 20 IU/mL, n = 954) groups. Overall survival (OS) and progression-free survival (PFS) were the primary endpoints. Logistic regression identified risk factors for LLV; Cox proportional hazards models assessed independent prognostic factors. Subgroup analyses were performed by treatment regimen and baseline HBV DNA load. Results: Multifactorial analysis identified HBeAg positivity (OR 1.971, 95% CI 1.53–2.541, p < 0.001), AST > 40 U/L (OR 1.437, 95% CI 1.126–1.832, p = 0.004), extrahepatic metastasis (OR 1.640, 95% CI 1.187–2.266, p = 0.003), and detectable baseline HBV DNA...