在调强放射治疗时代，基于顺铂的同步放化疗治疗局部和区域晚期鼻咽癌时血浆EB病毒DNA的预后价值
Prognostic Value of Plasma Epstein-Barr Virus DNA for Local and Regionally Advanced Nasopharyngeal Carcinoma Treated With Cisplatin-Based Concurrent Chemoradiotherapy in Intensity-Modulated Radiotherapy Era.
作者信息
Chen Wen-Hui, Tang Lin-Quan, Guo Shan-Shan, Chen Qiu-Yan, Zhang Lu, Liu Li-Ting, Qian Chao-Nan, Guo Xiang, Xie Dan, Zeng Mu-Sheng, Mai Hai-Qiang
机构信息
From the Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine (W-HC, L-QT, S-SG, Q-YC, LZ, L-TL, C-NQ, XG, DX, M-SZ, H-QM); and Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center (L-QT, S-SG, Q-YC, LZ, L-TL, C-NQ, XG , H-QM), Guangzhou, PR China.
出版信息
Medicine (Baltimore). 2016 Feb;95(5):e2642. doi: 10.1097/MD.0000000000002642.
This study aimed to evaluate the prognostic value of plasma Epstein-Barr Virus DNA (EBV DNA) for local and regionally advanced nasopharyngeal carcinoma (NPC) patients treated with concurrent chemoradiotherapy in intensity-modulated radiotherapy (IMRT) era.In this observational study, 404 nonmetastatic local and regionally advanced NPC patients treated with IMRT and cisplatin-based concurrent chemotherapy were recruited. Blood samples were collected before treatment for examination of plasma EBV DNA levels. We evaluated the association of pretreatment plasma EBV DNA levels with progression-free survival rate (PFS), distant metastasis-free survival rate (DMFS), and overall survival rate (OS).Compared to patients with an EBV DNA level < 4000 copies/mL, patients with an EBV DNA ≥ 4000 copies/mL had a lower rate of 3-year PFS (76%, 95% CI [68-84]) versus (93%, 95% CI [90-96], P < 0.001), DMFS (83%, 95% CI [76-89]) versus (97%, 95% CI [94-99], P < 0.001), and OS (85%, 95% CI [78-92]) versus (98%, 95% CI [95-100], P < 0.001). Multivariate analysis showed that pretreatment EBV DNA levels (HR = 3.324, 95% CI, 1.80-6.138, P < 0.001) and clinical stage (HR = 1.878, 95% CI, 1.036-3.404, P = 0.038) were the only independent factor associated with PFS, pretreatment EBV DNA level was the only significant factor to predict DMFS (HR = 6.292, 95% CI, 2.647-14.956, P < 0.001), and pretreatment EBV DNA levels (HR = 3.753, 95% CI, 1.701-8.284, P < 0.001) and clinical stage (HR = 2.577, 95% CI, 1.252-5.050, P = 0.010) were significantly associated with OS. In subgroup analysis, higher plasma EBV DNA levels still predicted a worse PFS, DMFS, and OS for the patients stage III or stage IVa-b, compared with those with low EBV DNA levels.Elevated plasma EBV DNA was still effective prognostic biomarker for local and regionally advanced NPC patients treated with IMRT and cisplatin-based concurrent chemotherapy. Future ramdomized clinical trials are needed to further evaluate whether plasma EBV DNA levels could be applied to guide concurrent chemotherapy regimen for local and regionally advanced NPC patients.
本研究旨在评估血浆EB病毒DNA（EBV DNA）对在调强放疗（IMRT）时代接受同步放化疗的局部及区域晚期鼻咽癌（NPC）患者的预后价值。在这项观察性研究中，招募了404例接受IMRT和顺铂同步化疗的非转移性局部及区域晚期NPC患者。在治疗前采集血样以检测血浆EBV DNA水平。我们评估了治疗前血浆EBV DNA水平与无进展生存率（PFS）、无远处转移生存率（DMFS）和总生存率（OS）之间的关联。与EBV DNA水平<4000拷贝/mL的患者相比，EBV DNA≥4000拷贝/mL的患者3年PFS率较低（76%，95%CI[68 - 84]），而（93%，95%CI[90 - 96]，P<0.001），DMFS率（83%，95%CI[76 - 89]），而（97%，95%CI[94 - 99]，P<0.001），OS率（85%，95%CI[78 - 92]），而（98%，95%CI[95 - 100]，P<0.001）。多因素分析显示，治疗前EBV DNA水平（HR = 3.324，95%CI，1.80 - 6.138，P<0.001）和临床分期（HR = 1.878，95%CI，1.036 - 3.404，P = 0.038）是与PFS相关的仅有的独立因素，治疗前EBV DNA水平是预测DMFS的唯一显著因素（HR = 6.292，95%CI，2.647 - 14.956，P<0.001），治疗前EBV DNA水平（HR = 3.753，95%CI，1.701 - 8.284，P<0.001）和临床分期（HR = 2.577，95%CI，1.252 - 5.050，P = 0.010）与OS显著相关。在亚组分析中，与低EBV DNA水平的患者相比，较高的血浆EBV DNA水平仍预示III期或IVa - b期患者的PFS、DMFS和OS更差。血浆EBV DNA升高仍是接受IMRT和顺铂同步化疗的局部及区域晚期NPC患者有效的预后生物标志物。未来需要进行随机临床试验，以进一步评估血浆EBV DNA水平是否可用于指导局部及区域晚期NPC患者的同步化疗方案。
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