Lin Shinn-Yn, Chang Kai-Ping, Hsieh Meng-Shu, Ueng Shir-Hwa, Hao Sheng-Po, Tseng Chen-Kan, Pai Ping-Ching, Chang Fu-Ti, Tsai Ming-Hsui, Tsang Ngan-Ming
Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou, Taiwan, ROC.
Int J Radiat Oncol Biol Phys. 2005 Dec 1;63(5):1339-46. doi: 10.1016/j.ijrobp.2005.05.051. Epub 2005 Sep 19.
The presence of Epstein-Barr virus latent membrane protein-1 (LMP-1) gene in nasopharyngeal swabs indicates the presence of nasopharyngeal carcinoma (NPC) mucosal tumor cells. This study was undertaken to investigate whether the time taken for LMP-1 to disappear after initiation of primary radiotherapy (RT) was inversely associated with NPC local control.
During July 1999 and October 2002, there were 127 nondisseminated NPC patients receiving serial examinations of nasopharyngeal swabbing with detection of LMP-1 during the RT course. The time for LMP-1 regression was defined as the number of days after initiation of RT for LMP-1 results to turn negative. The primary outcome was local control, which was represented by freedom from local recurrence.
The time for LMP-1 regression showed a statistically significant influence on NPC local control both univariately (p < 0.0001) and multivariately (p = 0.004). In multivariate analysis, the administration of chemotherapy conferred a significantly more favorable local control (p = 0.03). Advanced T status (> or = T2b), overall treatment time of external photon radiotherapy longer than 55 days, and older age showed trends toward being poor prognosticators. The time for LMP-1 regression was very heterogeneous. According to the quartiles of the time for LMP-1 regression, we defined the pattern of LMP-1 regression as late regression if it required 40 days or more. Kaplan-Meier plots indicated that the patients with late regression had a significantly worse local control than those with intermediate or early regression (p = 0.0129).
Among the potential prognostic factors examined in this study, the time for LMP-1 regression was the most independently significant factor that was inversely associated with NPC local control.
鼻咽拭子中存在爱泼斯坦-巴尔病毒潜伏膜蛋白1（LMP-1）基因表明存在鼻咽癌（NPC）黏膜肿瘤细胞。本研究旨在探讨初次放疗（RT）开始后LMP-1消失所需时间是否与NPC局部控制呈负相关。
1999年7月至2002年10月期间，127例未播散的NPC患者在放疗过程中接受了鼻咽拭子的系列检查以检测LMP-1。LMP-1消退时间定义为放疗开始后LMP-1结果转为阴性的天数。主要结局是局部控制，以无局部复发表示。
LMP-1消退时间在单因素分析（p < 0.0001）和多因素分析（p = 0.004）中均对NPC局部控制有统计学显著影响。在多因素分析中，化疗的实施赋予了显著更有利的局部控制（p = 0.03）。T分期晚期（≥T2b）、外照射光子放疗的总治疗时间超过55天以及年龄较大显示出预后不良的趋势。LMP-1消退时间非常不均一。根据LMP-1消退时间的四分位数，我们将LMP-1消退模式定义为如果需要40天或更长时间则为晚期消退。Kaplan-Meier曲线表明，晚期消退的患者局部控制明显比中期或早期消退的患者差（p = 0.0129）。
在本研究中检查的潜在预后因素中，LMP-1消退时间是与NPC局部控制呈负相关的最独立显著因素。
