Qiu Wenze, Lv Xing, Guo Xiang, Yuan Yawei
Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China.
State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
Front Oncol. 2020 Mar 31;10:356. doi: 10.3389/fonc.2020.00356. eCollection 2020.
Plasma Epstein-Barr virus (EBV) DNA has been determined as a prognostic factor in adult nasopharyngeal carcinoma (NPC) patients. This study was designed to evaluate the prognostic value of plasma pretreatment EBV DNA in children and adolescent NPC patients receiving intensity-modulated radiotherapy (IMRT). Pretreatment EBV DNA was retrospectively assessed in 147 children with newly diagnosed, non-metastatic NPC. All patients were treated using IMRT. Receiver operating characteristic (ROC) curve was used to identify the optimal EBV DNA cutoff point. Prognostic value was examined using a multivariate Cox proportional hazards model. The median follow-up for the entire cohort was 58 months (range, 10-119 months), and the 5-year survival rates for all patients were as follows: overall survival (OS), 88.7%; locoregional relapse-free survival, 95.2%; distant metastasis-free survival (DMFS), 84.8%; and disease-free survival (DFS), 81.5%. For ROC curve analysis, the optimal cutoff value of pretreatment EBV DNA load for DFS was 40,000 copies/mL. High plasma EBV DNA was significantly associated with poorer 5-year DMFS (70.6 vs. 89.1%, = 0.003) and DFS (63.9 vs. 86.9%, < 0.001). In multivariate analysis, high plasma EBV DNA was an independent predictor for DMFS and DFS. Pretreatment EBV DNA level was a powerful prognostic discriminator for DMFS and DFS in children and adolescent NPC patients treated with IMRT.
血浆 Epstein-Barr 病毒（EBV）DNA 已被确定为成人鼻咽癌（NPC）患者的一个预后因素。本研究旨在评估血浆预处理 EBV DNA 在接受调强放疗（IMRT）的儿童和青少年 NPC 患者中的预后价值。对 147 例新诊断的非转移性 NPC 儿童患者的预处理 EBV DNA 进行了回顾性评估。所有患者均接受 IMRT 治疗。采用受试者工作特征（ROC）曲线确定 EBV DNA 的最佳截断点。使用多变量 Cox 比例风险模型检验预后价值。整个队列的中位随访时间为 58 个月（范围 10 - 119 个月），所有患者的 5 年生存率如下：总生存率（OS）为 88.7%；局部区域无复发生存率为 95.2%；远处转移无复发生存率（DMFS）为 84.8%；无病生存率（DFS）为 81.5%。对于 ROC 曲线分析，DFS 的预处理 EBV DNA 负荷最佳截断值为 40,000 拷贝/mL。高血浆 EBV DNA 与较差的 5 年 DMFS（70.6% 对 89.1%，P = 0.003）和 DFS（63.9% 对 86.9%，P < 0.001）显著相关。在多变量分析中，高血浆 EBV DNA 是 DMFS 和 DFS 的独立预测因素。预处理 EBV DNA 水平是接受 IMRT 治疗的儿童和青少年 NPC 患者 DMFS 和 DFS 的有力预后判别指标。
