Jin Ya-Nan, Yao Ji-Jin, Zhang Fan, Wang Si-Yang, Zhang Wang-Jian, Zhou Guan-Qun, Qi Zhen-Yu, Sun Ying
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong Province, People's Republic of China.
Department of Radiation Oncology, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519001, Guangdong Province, China.
J Cancer. 2017 Mar 12;8(6):976-982. doi: 10.7150/jca.18124. eCollection 2017.
The objective of this study was to confirm the association between pretreatment Epstein-Barr virus (EBV) DNA (pre-DNA) load and survival outcomes after long-term follow-up in patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC). Between November 2009 and February 2012, a total of 1036 patients with LA-NPC were enrolled. There were 762 patients in stage III and 274 in stage IVA-B. All patients were treated with radical radiotherapy with or without chemotherapy, and pre-DNA concentrations were quantified by a polymerase chain reaction assay. Patient outcomes were evaluated. The 5-year overall survival (OS), distant metastasis-free surviva (DMFS), locoregional relapse-free survival (LRFS), and progression-free survival (PFS) rates were 84.7%, 87.0%, 90.2%, and 77.1%, respectively. By using previously defined pre-DNA cutoff value (1500 copies/ml pretreatment), pre-DNA was an independent prognostic predictor for OS, DMFS, and PFS using log-rank test. Multivariate Cox analysis also confirmed these results. Subgroup analysis indicated that the 5-year OS, DMFS, and PFS rates in patients staged IVA-B with pre-DNA < 1500 copies/ml were similar to those patients staged III with pre-DNA ≥ 1500 copies/ml, whereas patients staged IVA-B patients with pre-DNA ≥ 1500 copies/ml predicted worse outcome. In this expanded study, the prognostic significance of pre-DNA was confirmed using predefined cutoff value in an independent patient group, and pre-DNA was identified as an independent prognostic marker for the risk stratification in LA-NPC.
本研究的目的是在局部区域晚期鼻咽癌（LA-NPC）患者长期随访后，确认预处理时的爱泼斯坦-巴尔病毒（EBV）DNA（pre-DNA）载量与生存结果之间的关联。2009年11月至2012年2月，共纳入1036例LA-NPC患者。其中III期患者762例，IVA-B期患者274例。所有患者均接受了根治性放疗，部分患者联合化疗，采用聚合酶链反应检测法对pre-DNA浓度进行定量。评估患者的预后情况。5年总生存率（OS）、无远处转移生存率（DMFS）、无局部区域复发生存率（LRFS）和无进展生存率（PFS）分别为84.7%、87.0%、90.2%和77.1%。使用先前定义的pre-DNA临界值（预处理时1500拷贝/ml），通过对数秩检验，pre-DNA是OS、DMFS和PFS的独立预后预测指标。多变量Cox分析也证实了这些结果。亚组分析表明，pre-DNA＜1500拷贝/ml的IVA-B期患者的5年OS、DMFS和PFS率与pre-DNA≥1500拷贝/ml的III期患者相似，而pre-DNA≥1500拷贝/ml的IVA-B期患者预后较差。在这项扩大研究中，在一个独立患者组中使用预定义临界值证实了pre-DNA的预后意义，并将pre-DNA确定为LA-NPC风险分层的独立预后标志物。
