Liu Ting-Bo, Zheng Zhi-Hong, Pan Jie, Pan Li-Li, Chen Li-Hong
Fujian Institute of Hematology, Fujian Provincial Key Laboratory of Hematology, Fujian Medical University Union Hospital, Fuzhou 350001, China.
Clin Invest Med. 2017 Feb 19;40(1):E1-E12. doi: 10.25011/cim.v40i1.28049.
Predicting prognosis and treatment outcomes for patients with for nasopharyngeal carcinoma (NPC) has been difficult due to the heterogeneous nature of the disease This study aimed to evaluate pretreatment copy number of plasma Epstein-Barr virus (EBV) DNA as an outcome marker for survival in NPC.
MEDLINE, CENTRAL and Embase databases were searched until April 7, 2015. Included studies were randomized controlled trials, two-arm prospective studies, or retrospective studies in patients with newly diagnosed NPC. The primary outcome was overall survival and secondary outcomes were progression-free, relapse-free, disease-free and distant metastasis-free survival. Sensitivity, quality and publication bias assessments were performed.
Sixteen studies were included in the meta-analysis, with a total of 7698 patients. For overall survival, pooled HR was 3.005 (95% confidence interval [CI] = 2.245-4.022; P < 0.001), indicating that higher levels of EBV DNA were associated with a greater risk of death. Pooled estimates for relapse-free, disease-free, progression-free and distant metastasis-free survival indicated that higher levels of EBV DNA were associated with an increased risk of relapse, disease recurrence, disease progression and distant metastasis in comparison with lower levels of EBV DNA (P values < 0.001).
This meta-analysis found that high EBV DNA levels indicate poor prognosis and reduced long-term survival in patients with newly diagnosed NPC; hence, EBV DNA levels are highly prognostic of survival in patients with NPC. None of the included studies used the WHO standard for EBV DNA measurement, indicating a greater need for harmonization in future studies.
由于鼻咽癌（NPC）具有异质性，预测其患者的预后和治疗结果一直很困难。本研究旨在评估血浆Epstein-Barr病毒（EBV）DNA的预处理拷贝数作为NPC患者生存的结果标志物。
检索MEDLINE、CENTRAL和Embase数据库至2015年4月7日。纳入的研究为随机对照试验、双臂前瞻性研究或新诊断NPC患者的回顾性研究。主要结局为总生存期，次要结局为无进展生存期、无复发生存期、无病生存期和无远处转移生存期。进行了敏感性、质量和发表偏倚评估。
荟萃分析纳入16项研究，共7698例患者。对于总生存期，合并风险比（HR）为3.005（95%置信区间[CI]=2.245-4.022；P<0.001），表明EBV DNA水平较高与死亡风险增加相关。无复发生存期、无病生存期、无进展生存期和无远处转移生存期的合并估计表明，与较低水平的EBV DNA相比，较高水平的EBV DNA与复发、疾病复发、疾病进展和远处转移风险增加相关（P值<0.001）。
这项荟萃分析发现，高EBV DNA水平表明新诊断的NPC患者预后不良且长期生存率降低；因此，EBV DNA水平对NPC患者的生存具有高度预后价值。纳入的研究均未使用WHO的EBV DNA测量标准，表明未来研究更需要进行统一。
