血浆EB病毒DNA水平在鼻咽癌患者新辅助化疗前后的预后价值
Prognostic Value of Plasma Epstein-Barr Virus DNA Levels Pre- and Post-Neoadjuvant Chemotherapy in Patients With Nasopharyngeal Carcinoma.
作者信息
Zhu Lisheng, Ouyang Tao, Xiong Ying, Ba Li, Li Qiuting, Qiu Mengjun, Zou Zhenwei, Peng Gang
机构信息
Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
出版信息
Front Oncol. 2021 Sep 16;11:714433. doi: 10.3389/fonc.2021.714433. eCollection 2021.
BACKGROUND
In this study, we evaluated the prognostic value of the plasma levels of Epstein-Barr virus (EBV) DNA in patients with nasopharyngeal carcinoma (NPC) at different treatment stages.
METHODS
We retrospectively analyzed the Data of 206 patients with NPC. Pre-neoadjuvant chemotherapy (pre-NACT), post-NACT, post-radiotherapy, and post-treatment plasma EBV DNA levels were used to establish prognostic nomograms. The concordance index (C-index) and calibration curves were used to compare the prognostic accuracy of the nomograms. The results were confirmed in a validation cohort consisting of patients who were tested for EBV DNA levels at all four stages of treatment. The Kaplan-Meier method was used to calculate the progression-free survival (PFS) and overall survival (OS). Survival differences were calculated using the log-rank test.
RESULTS
EBV DNA-positive patients had worse 3-year PFS and 5-year OS than EBV DNA-negative patients; this was true for pre-NACT (PFS: 82.7% . 57.3%, < 0.001; OS: 90.9% . 68.7%, = 0.08) and post-NACT (PFS: 85.0% . 50.6%, < 0.001; OS: 91.7% . 65.7%; = 0.001) EBV DNA levels but not for post-radiotherapy (PFS: 72.2% . 60.9%, = 0.192; OS: 73.1% . 77.2%, = 0.472) or post-treatment (PFS: 77.3% . 59.2%, = 0.063; OS: 77.5% . 79.7%, = 0.644) levels. Nomograms combining pre-NACT and post-NACT EBV DNA levels had a superior prognostic ability than those of post-radiotherapy and post-treatment EBV DNA levels.
CONCLUSION
Pre-NACT EBV DNA levels combined with post-NACT EBV DNA levels can more reliably predict survival outcomes in patients with NPC.
背景
在本研究中，我们评估了不同治疗阶段鼻咽癌（NPC）患者血浆中爱泼斯坦-巴尔病毒（EBV）DNA水平的预后价值。
方法
我们回顾性分析了206例NPC患者的数据。采用新辅助化疗前（pre-NACT）、新辅助化疗后、放疗后及治疗后血浆EBV DNA水平建立预后列线图。一致性指数（C指数）和校准曲线用于比较列线图的预后准确性。在一个由在治疗的所有四个阶段检测EBV DNA水平的患者组成的验证队列中对结果进行了验证。采用Kaplan-Meier方法计算无进展生存期（PFS）和总生存期（OS）。使用对数秩检验计算生存差异。
结果
EBV DNA阳性患者的3年PFS和5年OS比EBV DNA阴性患者差；pre-NACT（PFS：82.7%对57.3%，P<0.001；OS：90.9%对68.7%，P = 0.08）和新辅助化疗后（PFS：85.0%对50.6%，P<0.001；OS：91.7%对65.7%；P = 0.001）的EBV DNA水平情况如此，但放疗后（PFS：72.2%对60.9%，P = 0.192；OS：73.1%对77.2%，P = 0.472）或治疗后（PFS：77.3%对59.2%，P = 0.063；OS：77.5%对79.7%，P = 0.644）的水平并非如此。结合pre-NACT和新辅助化疗后EBV DNA水平的列线图比放疗后和治疗后EBV DNA水平的列线图具有更好的预后能力。
结论
pre-NACT EBV DNA水平与新辅助化疗后EBV DNA水平相结合能够更可靠地预测NPC患者的生存结局。
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