Tsang Ngan-Ming, Chuang Chi-Cheng, Tseng Chen-Kan, Hao Sheng-Po, Kuo Tseng-Tong, Lin Chien-Yu, Pai Ping-Ching
Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou, Taiwan, Republic of China.
Cancer. 2003 Dec 1;98(11):2385-92. doi: 10.1002/cncr.11820.
Nasopharyngeal carcinoma (NPC) is the most common head and neck malignancy in southeastern China and Taiwan. Early detection of the local disease followed by timely and appropriate treatment is essential to increasing cure and survival rates. Detection of Epstein-Barr virus (EBV) genomic DNA, such as the latent membrane protein 1 gene (LMP-1), in patients postirradiation during follow-up may indicate mucosal recurrence.
Seventy-one patients with NPC underwent serial nasopharyngeal swabs for LMP-1 polymerase chain reaction assay before, during, and after irradiation. All of patients achieved a complete disease remission of the LMP-1 gene after irradiation that lasted for at least 6 months.
The median LMP-1 disease remission time after the beginning of irradiation was 4.3 weeks. Patients with early LMP-1 disease remission (</= 4 weeks after the beginning of irradiation) and delayed LMP-1 disease remission (> 4 weeks) had 3-year local control rates of 93.5% and 76.9%, respectively (P = 0.0529). The LMP-1 gene was detected again (reexpression of LMP-1 [re-LMP-1]) in 10 patients after irradiation with at least 6 months of follow-up. Nine of 10 patients (90%) in the re-LMP-1 positive group and 2 of 61 patients (3.3%) in the re-LMP-1 negative group developed local recurrence. Mucosal recurrence developed in nine patients, and all displayed re-LMP-1. By detecting re-LMP-1 using nasopharyngeal swabs, mucosal recurrence was diagnosed with a sensitivity of 100% (9 of 9 patients) and a specificity of 98.4% (61 of 62 patients). The 3-year overall survival rate, the disease free survival rate for the entire group, and the estimated local mucosal control rates in the re-LMP-1 positive and re-LMP-1 negative groups were 86.5%, 76.5%, 19.4%, and 96.7%, respectively.
Expression of EBV LMP-1 in nasopharyngeal swab specimens from patients with irradiated/treated NPC can provide a highly sensitive and specific method of forecasting mucosal recurrence. This investigation confirmed the reliability and feasibility of nasopharyngeal swabs in screening for mucosal recurrences in patients with NPC.
鼻咽癌（NPC）是中国东南部和台湾地区最常见的头颈部恶性肿瘤。早期发现局部疾病并及时进行适当治疗对于提高治愈率和生存率至关重要。在随访期间对接受放疗后的患者检测爱泼斯坦-巴尔病毒（EBV）基因组DNA，如潜伏膜蛋白1基因（LMP-1），可能提示黏膜复发。
71例鼻咽癌患者在放疗前、放疗期间和放疗后接受了一系列鼻咽拭子检查，用于LMP-1聚合酶链反应检测。所有患者放疗后LMP-1基因均实现了至少持续6个月的完全疾病缓解。
放疗开始后LMP-1疾病缓解的中位时间为4.3周。放疗开始后LMP-1疾病早期缓解（≤4周）和延迟缓解（>4周）的患者3年局部控制率分别为93.5%和76.9%（P = 0.0529）。在至少随访6个月的放疗后，10例患者再次检测到LMP-1基因（LMP-1重新表达[re-LMP-1]）。re-LMP-1阳性组的10例患者中有9例（90%）发生局部复发，re-LMP-1阴性组的61例患者中有2例（3.3%）发生局部复发。9例患者发生黏膜复发，均表现为re-LMP-1。通过鼻咽拭子检测re-LMP-1，诊断黏膜复发的敏感性为100%（9/9例患者），特异性为98.4%（61/62例患者）。re-LMP-1阳性组和re-LMP-1阴性组的3年总生存率、全组无病生存率以及估计的局部黏膜控制率分别为86.5%、76.5%、19.4%和96.7%。
接受放疗/治疗的鼻咽癌患者鼻咽拭子标本中EBV LMP-1的表达可为预测黏膜复发提供一种高度敏感和特异的方法。本研究证实了鼻咽拭子在筛查鼻咽癌患者黏膜复发方面的可靠性和可行性。
