采用小沟结合剂探针实时定量PCR检测血浆爱泼斯坦-巴尔病毒DNA对接受同步放化疗的鼻咽癌患者的长期预后影响。

Long-term prognostic effects of plasma epstein-barr virus DNA by minor groove binder-probe real-time quantitative PCR on nasopharyngeal carcinoma patients receiving concurrent chemoradiotherapy.

作者信息

Lin Jin-Ching, Wang Wen-Yi, Liang Wen-Miin, Chou Hsin-Yi, Jan Jian-Sheng, Jiang Rong-San, Wang Ju-Yu, Twu Chih-Wen, Liang Kai-Li, Chao Jeffrey, Shen Wu-Chung

机构信息

Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan.

出版信息

Int J Radiat Oncol Biol Phys. 2007 Aug 1;68(5):1342-8. doi: 10.1016/j.ijrobp.2007.02.012. Epub 2007 Apr 20.

DOI:10.1016/j.ijrobp.2007.02.012

PMID:17449194

Abstract

PURPOSE

To evaluate the long-term prognostic impact of plasma Epstein-Barr virus (EBV) DNA concentration measured by real-time quantitative polymerase chain reaction (RTQ-PCR) in nasopharyngeal carcinoma (NPC) patients receiving concurrent chemoradiotherapy (CCRT).

METHODS AND MATERIALS

Epstein-Barr virus DNA was retrospectively measured from stock plasma of 152 biopsy-proven NPC patients with Stage II-IV (M0) disease with a RTQ-PCR using the minor groove binder-probe. All patients received CCRT with a median follow-up of 78 months. We divided patients into three subgroups: (1) low pretreatment EBV DNA (<1,500 copies/mL) and undetectable posttreatment EBV DNA (pre-L/post-U), (2) high pretreatment EBV DNA (> or =1,500 copies/mL) and undetectable posttreatment EBV DNA (pre-H/post-U), and (3) low or high pretreatment EBV DNA and detectable posttreatment EBV DNA (pre-L or H/post-D) for prognostic analyses.

RESULTS

Epstein-Barr virus DNA (median concentration, 573 copies/mL; interquartile range, 197-3,074) was detected in the pretreatment plasma of 94.1% (143/152) of patients. After treatment, plasma EBV DNA decreased or remained 0 for all patients and was detectable in 31 patients (20.4%) with a median concentration 0 copy/mL (interquartile range, 0-0). The 5-year overall survival rates of the pre-L/post-U, pre-H/post-U, and pre-L or H/post-D subgroups were 87.2%, 71.0%, and 38.7%, respectively (p < 0.0001). The relapse-free survival showed similar results with corresponding rates of 85.6%, 75.9%, and 26.9%, respectively (p < 0.0001). Multivariate Cox analysis confirmed the superior effects of plasma EBV DNA compared to other clinical parameters in prognosis prediction.

CONCLUSION

Plasma EBV DNA is the most valuable prognostic factor for NPC. More chemotherapy should be considered for patients with persistently detectable EBV DNA after CCRT.

摘要

目的

评估实时定量聚合酶链反应（RTQ-PCR）检测的血浆爱泼斯坦-巴尔病毒（EBV）DNA浓度对接受同步放化疗（CCRT）的鼻咽癌（NPC）患者的长期预后影响。

方法和材料

采用小沟结合剂探针的RTQ-PCR方法，对152例经活检证实为II-IV期（M0）疾病的NPC患者的储存血浆进行回顾性EBV DNA检测。所有患者均接受CCRT，中位随访时间为78个月。我们将患者分为三个亚组：（1）治疗前EBV DNA水平低（<1500拷贝/mL）且治疗后EBV DNA检测不到（治疗前低/治疗后未检测到），（2）治疗前EBV DNA水平高（≥1500拷贝/mL）且治疗后EBV DNA检测不到（治疗前高/治疗后未检测到），以及（3）治疗前EBV DNA水平低或高且治疗后EBV DNA可检测到（治疗前低或高/治疗后可检测到），进行预后分析。

结果

94.1%（143/152）的患者治疗前血浆中检测到EBV DNA（中位浓度为573拷贝/mL；四分位间距为197-3074）。治疗后，所有患者血浆EBV DNA下降或保持为0，31例患者（20.4%）可检测到，中位浓度为0拷贝/mL（四分位间距为0-0）。治疗前低/治疗后未检测到、治疗前高/治疗后未检测到和治疗前低或高/治疗后可检测到亚组的5年总生存率分别为87.2%、71.0%和38.7%（p<0.0001）。无复发生存率结果相似，相应比例分别为85.6%、75.9%和26.9%（p<0.0001）。多变量Cox分析证实，与其他临床参数相比，血浆EBV DNA在预后预测方面具有更优的效果。