Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan; Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, United Kingdom.
Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan.
Radiother Oncol. 2022 Dec;177:1-8. doi: 10.1016/j.radonc.2022.05.004. Epub 2022 May 11.
To determine the clinical impact of integrating Epstein-Barr virus (EBV) DNA and lymph node-to-primary tumor ratio (NTR) of positron emission tomography (PET) standardized uptake value (SUV) in predicting distant metastasis, such as distant metastasis-free survival (DMFS), in patients with nasopharyngeal carcinoma (NPC).
We retrospectively reviewed patients diagnosed with non-disseminated NPC between 2010 and 2017. The optimal cut-off values of EBV DNA and SUV NTR were determined using receiver operating characteristic analysis. The prognostic values of SUV NTR and EBV DNA on DMFS and overall survival were evaluated using the Kaplan-Meier method. Univariate and multivariable analyses were performed using the Wald Chi-squared test and Cox proportional hazards regression, respectively.
A total of 488 patients were included in the analysis. The median follow-up period was 61.6 months. The optimal cut-off values of EBV DNA and SUV NTR were 3377.5 copies per mL and 0.64, respectively. The five-year DMFS for patients with high vs low EBV DNA and SUV NTR levels were 64.9% vs 86.6% (p < 0.001) and 78.7% vs 87.4% (p = 0.021), respectively. In subgroup analysis, the high-risk group with high levels of pretreatment EBV DNA and SUV NTR had worse DMFS in either American Joint Committee on Cancer (AJCC) stage I-III or IVA-B (p = 0.001 and <0.001, respectively). Univariate and multivariable analyses showed the statistical significance of EBV DNA, SUV NTR, and their composite in DMFS (p < 0.001 for EBV DNA; p = 0.022 for SUV NTR; p < 0.001 for their composite).
This study showed that EBV DNA and SUV NTR have independent and additive values as prognosticators for distant metastasis in patients with NPC, suggesting that these two individual factors, except the AJCC staging system, should be included in future studies.
为了确定将 EBV 病毒（EBV）DNA 和正电子发射断层扫描（PET）标准化摄取值（SUV）的淋巴结与原发肿瘤比值（NTR）整合以预测远处转移（如无远处转移生存（DMFS））的临床意义，对 2010 年至 2017 年间诊断为非转移性 NPC 的患者进行回顾性研究。采用受试者工作特征分析确定 EBV DNA 和 SUV NTR 的最佳截断值。采用 Kaplan-Meier 法评估 SUV NTR 和 EBV DNA 对 DMFS 和总生存率的预后价值。采用 Wald Chi-squared 检验和 Cox 比例风险回归分别进行单因素和多因素分析。
共纳入 488 例患者进行分析。中位随访时间为 61.6 个月。EBV DNA 和 SUV NTR 的最佳截断值分别为 3377.5 拷贝/毫升和 0.64。高 EBV DNA 和 SUV NTR 水平的患者五年 DMFS 为 64.9%比 86.6%（p<0.001）和 78.7%比 87.4%（p=0.021）。亚组分析显示，高风险组的患者在 AJCC Ⅰ-Ⅲ期或ⅣA-B 期时，高 EBV DNA 和 SUV NTR 水平预示着较差的 DMFS（p=0.001 和 <0.001）。单因素和多因素分析显示 EBV DNA、SUV NTR 及其复合因素在 DMFS 中的统计学意义（p<0.001 为 EBV DNA；p=0.022 为 SUV NTR；p<0.001 为其复合因素）。
本研究表明 EBV DNA 和 SUV NTR 作为 NPC 患者远处转移的独立且具有附加价值的预测因子，提示这两个个体因素，除了 AJCC 分期系统外，应纳入未来的研究中。
