In a groundbreaking retrospective study published in BMC Cancer, researchers have revealed compelling evidence linking chronic hepatitis B virus (HBV) infection to poorer survival outcomes in patients suffering from oral squamous cell carcinoma (OSCC). This extensive investigation, spanning a decade and involving 1,373 patients treated at the Hospital of Stomatology, Sun Yat-sen University, sheds new light on the intersection of viral infection and cancer prognosis, underscoring the urgent need for integrated screening and management strategies in oncology.
Oral squamous cell carcinoma represents the predominant category of head and neck cancers worldwide, notorious for its aggressive progression and substantial morbidity. While the association between HBV—a virus primarily known for its hepatic complications—and liver cancers is well-documented, this study uniquely highlights HBV’s clinical implications beyond the liver, particularly its influence on extrahepatic malignancies like OSCC. The researchers embarked on a mission to decode whether active HBV infection affects cancer advancement or patient survival, a question that has remained largely unexplored until now.
The team utilized hepatitis B surface antigen (HBsAg) seropositivity as a biomarker to determine active HBV infection status among OSCC patients. Through rigorous propensity score matching based on variables including age, sex, and cancer staging, the study meticulously compared clinical outcomes between HBV-positive and HBV-negative cohorts. Such methodological precision lends robustness to their conclusions, minimizing confounding effects and allowing a clearer understanding of HBV’s role in OSCC prognosis.
Remarkably, the prevalence of HBV infection within this cohort stood at 12%, with the HBsAg-positive group predominantly comprising younger patients under 60 years old. This demographic nuance may reflect epidemiological trends of HBV exposure but also raises questions about viral oncogenesis accelerating cancer evolution in younger populations. The age distribution itself could have profound implications for screening protocols and tailored therapeutic approaches in clinical practice.
Survival analyses revealed that patients harboring HBV exhibited significantly diminished overall survival (OS) and disease-free survival (DFS) rates at five years post-diagnosis compared to their HBV-negative counterparts. This disparity was especially pronounced among individuals presenting with advanced-stage disease and cervical lymph node metastasis, emphasizing the compounded risks HBV infection introduces to an already precarious prognosis. These findings highlight HBV as a formidable adversary in the fight against OSCC, influencing not only cancer biology but also clinical outcomes.
Further, multivariate analyses established that the absence of HBsAg—indicative of no active HBV infection—served as an independent protective prognostic factor, halving the hazard ratio for mortality and reducing disease recurrence risks. This statistical evidence crystalizes the prognostic significance of HBV status in OSCC, suggesting that viral infection status should be integrated into routine oncological assessments, much like traditional staging parameters.
One of the study’s most intriguing revelations pertains to the role of elective neck dissection in OSCC patients with concurrent HBV infection. Neck dissection, a surgical procedure aimed at removing potentially affected lymphatic tissues, emerged as an independent protective factor contributing to improved survival outcomes in this subgroup. This insight not only informs surgical decision-making but also prompts reevaluation of treatment algorithms where viral infection complicates the oncologic landscape.
Conversely, established risk factors such as depth of invasion (DOI) and pathological nodal status continued to predict adverse prognosis, reaffirming their critical place in the pathology of OSCC. The interplay of these tumor characteristics with viral infection underscores a multifactorial framework determining patient outcomes, where viral, pathological, and therapeutic variables intersect to shape survival trajectories.
The implications of these findings extend beyond clinical prognostication. The authors advocate for routine HBV screening prior to initiating tumor therapies in OSCC patients, a recommendation grounded in the dual imperative of optimizing cancer outcomes and preventing HBV reactivation. Given that cancer treatments, especially chemotherapy and immunotherapy, can precipitate viral reactivation with potentially fatal consequences, pre-treatment viral assessment and prophylactic antiviral therapy emerge as indispensable components of comprehensive patient management.
Moreover, the study underscores the potential benefits of antiviral prophylaxis and systematic serological monitoring throughout the cancer treatment continuum. By curtailing viral activity, clinicians may not only safeguard liver function but also potentially modulate tumor behavior indirectly influenced by chronic infection and inflammation. This integrated care model exemplifies precision medicine’s promise in tailoring interventions based on viral and tumor biology.
Intriguingly, the study’s retrospective design encompassing a large patient population over ten years adds significant weight to the clinical correlations observed, yet it simultaneously encourages future prospective studies and mechanistic investigations. Understanding how HBV mechanistically influences OSCC tumorigenesis, immune evasion, or microenvironment alterations could pave the way for novel therapeutic targets, potentially improving survival in this vulnerable patient population.
Furthermore, these data raise important public health considerations, particularly in HBV-endemic regions where OSCC incidence is also high. Integrating viral screening into head and neck cancer programs could lead to earlier detection of at-risk patients and adaptive treatment strategies, ultimately mitigating the compounded burden of OSCC and HBV co-morbidity. Such multidisciplinary approaches are vital to reducing cancer mortality on a global scale.
While the precise biological pathways underpinning HBV’s impact on OSCC remain to be fully elucidated, the study fortifies the hypothesis that chronic viral infection modulates carcinogenesis far beyond the liver. It may invoke chronic inflammatory states, immune dysregulation, and direct oncogenic viral effects, all of which could influence tumor progression and response to therapy. These emerging concepts invite a paradigm shift in how oncologists and virologists collaborate.
In conclusion, this comprehensive analysis offers compelling evidence that hepatitis B virus infection constitutes a critical prognostic marker for oral squamous cell carcinoma, influencing survival outcomes significantly. The findings advocate for routine HBV screening, vigilant serological monitoring, and consideration of elective neck dissection in HBV-positive early-stage OSCC patients. These insights not only enhance our understanding of viral-oncologic interplay but also hold tangible implications for optimizing patient-tailored therapeutic strategies and improving survival statistics.
As cancer research continues to unravel the intricate nexus between infections and malignancies, studies like this illuminate the path toward integrative, multidisciplinary cancer care. They reinforce the necessity of considering viral status in oncologic paradigms, potentially reshaping treatment standards and offering new hope to patients worldwide grappling with the dual challenges of cancer and chronic infection.
Subject of Research: Clinical correlation and survival analysis of hepatitis B virus infection in oral squamous cell carcinoma patients.
Article Title: Clinical correlation and survival analysis of hepatitis B virus infection in oral squamous cell carcinoma: a retrospective study of 1373 patients.
Article References:
Tan, R., Zhu, Y., Chen, Z. et al. Clinical correlation and survival analysis of hepatitis B virus infection in oral squamous cell carcinoma: a retrospective study of 1373 patients. BMC Cancer 25, 801 (2025). https://doi.org/10.1186/s12885-025-14188-8
Image Credits: Scienmag.com
DOI: https://doi.org/10.1186/s12885-025-14188-8
Tags: cancer progression and viral infectionschronic HBV infection and OSCCextrahepatic malignancies and hepatitis BHBsAg seropositivity in cancer patientshead and neck cancer survival ratesHepatitis B virus impact on cancer survivalintegrated cancer screening strategiesmorbidity in oral cancer patients.oncology management of HBV patientsoral squamous cell carcinoma prognosisretrospective study on HBV and cancerviral infections and cancer outcomes
