He X F, Yu X, Ji M F, Fu M Y
Department of Otolaryngology, Zhongshan People's Hospital, Zhongshan, 528403, China.
Cancer Research Institute, Zhongshan People's Hospital.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2017 May 20;31(10):770-773. doi: 10.13201/j.issn.1001-1781.2017.10.008.
The aim of this study is to evaluate the level of plasma EBV DNA and nasal endoscopy in high risk population of nasopharyngeal carcinoma, and to explore the value of EBV DNA testing in nasal endoscopy. The nasopharyngeal carcinoma was screened in High-incidence Area of Zhongshan City. EBV antibody was detected by ELISA, and 427 patients with high risk of nasopharyngeal carcinoma were identified. In the high risk population the plasma EBV-DNA was measured using Fluorescent quantitative PCR, and all patients were used nasal endoscopy in the first two years. The application value of EBV DNA and nasopharyngeal endoscopic biopsy were analyzed. There were 427 NPC high risk population in first screening. The rates of nasopharyngeal biopsy in EBV DNA positive and EBV DNA negative population were 90.2% (55/61) and 13.9% (51/366), respectively. The rate of NPC nasopharyngeal biopsy in EBV DNA positive population was higher than that in EBV DNA negative population (<0.01). The rate of NPC detection in EBV DNA positive group (60.7%) was higher than that (3.3%) in EBV DNA negative population (<0.01). In first year follow up, there were 286 NPC high risk population. The rates of nasopharyngeal biopsy in EBV DNA positive and EBV DNA negative population were 91.2% (31/34) and 11.9% (30/252), respectively. The rate of NPC nasopharyngeal biopsy in EBV DNA positive population was higher than that in EBV DNA negative population (<0.01). The rate of NPC detection in EBV DNA positive group (17.6%) was higher than that (1.6%) in EBV DNA negative population (<0.01). The positive predicative value of serological risk assessment was 8.3% (59/713), but for NPC high risk group, adding quantitative analysis of plasma EBV DNA, the positive predicative value was 45.3% (43/95). The early diagnosis rates in EBV DNA positive and EBV DNA negative population were 79.1% (34/43) and 93.8% (15/16), respectively. There was no significant difference in early diagnosis rates in two groups (>0.05). The positive rate of plasma EBV DNA in high risk group of nasopharyngeal carcinoma may be helpful for nasal endoscopic nasopharyngeal biopsy, which can greatly improve the positive predictive value of high risk population of nasopharyngeal carcinoma. For NPC high risk population, Therefore, EBV DNA positive population are the focus for NPC screening.
本研究旨在评估鼻咽癌高危人群的血浆EBV DNA水平及鼻内镜检查情况，探讨EBV DNA检测在鼻内镜检查中的价值。在中山市高发区进行鼻咽癌筛查。采用ELISA法检测EBV抗体，共识别出427例鼻咽癌高危患者。在高危人群中，采用荧光定量PCR法检测血浆EBV-DNA，并在最初两年对所有患者进行鼻内镜检查。分析EBV DNA和鼻咽内镜活检的应用价值。首次筛查时有427例鼻咽癌高危人群。EBV DNA阳性人群和EBV DNA阴性人群的鼻咽活检率分别为90.2%（55/61）和13.9%（51/366）。EBV DNA阳性人群的鼻咽癌鼻咽活检率高于EBV DNA阴性人群（<0.01）。EBV DNA阳性组的鼻咽癌检出率（60.7%）高于EBV DNA阴性人群（3.3%）（<0.01）。在第一年随访中，有286例鼻咽癌高危人群。EBV DNA阳性人群和EBV DNA阴性人群的鼻咽活检率分别为91.2%（31/34）和11.9%（30/252）。EBV DNA阳性人群的鼻咽癌鼻咽活检率高于EBV DNA阴性人群（<0.01）。EBV DNA阳性组的鼻咽癌检出率（17.6%）高于EBV DNA阴性人群（1.6%）（<0.01）。血清学风险评估的阳性预测值为8.3%（59/713），但对于鼻咽癌高危组，增加血浆EBV DNA定量分析后，阳性预测值为45.3%（43/95）。EBV DNA阳性人群和EBV DNA阴性人群的早期诊断率分别为79.1%（34/43）和93.8%（15/16）。两组早期诊断率无显著差异（>0.05）。鼻咽癌高危组血浆EBV DNA阳性率可能有助于鼻内镜下鼻咽活检，可大大提高鼻咽癌高危人群的阳性预测值。因此，对于鼻咽癌高危人群，EBV DNA阳性人群是鼻咽癌筛查的重点。
