诱导化疗后 Epstein-Barr 病毒 DNA 变化水平与肿瘤体积减少率联合作为局部晚期鼻咽癌的更好预后预测指标。
Epstein-Barr virus DNA change level combined with tumor volume reduction ratio after inductive chemotherapy as a better prognostic predictor in locally advanced nasopharyngeal carcinoma.
机构信息
Department of Head and Neck Oncology, Cancer Center, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China.
State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China.
出版信息
Cancer Med. 2023 Jan;12(2):1102-1113. doi: 10.1002/cam4.4964. Epub 2022 Jul 19.
BACKGROUND
To explore the prognosis predicting ability of the combined factors, Epstein-Barr virus DNA change level (EBVCL) and tumor volume reduction ratio (TVRR) after inductive chemotherapy (IC), in locally advanced nasopharyngeal carcinoma (LANPC).
METHODS
From 2010 to 2018, 299 LANPC patients were included in this retrospective study. Receiver operating characteristic (ROC) curve analysis was performed to acquire the best critical values. According to the best critical values of EBVCL and TVRR, patients were stratified into low- and high-risk groups. Kaplan-Meier and ROC curve analyses were utilized to verify the prognostic ability of the new predictor (EBVCL+TVRR). The prognostic values among EBVCL+TVRR, EBVCL, TVRR, TNM stage, and the RECIST 1.1 criteria were compared by ROC curve. The primary end points were overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and locoregional failure-free survival (LRFFS).
RESULTS
ROC curve analyses of TVRR on three-year survival showed the best critical values of TVRR was 32.72% for OS, 30.21% for PFS and LRFFS, 29.87% for DMFS. The best critical value of EBVCL was 127 copies/ml for OS, and 87.7 copies/ml for PFS, DMFS, and LRFFS. The three-year OS, PFS, DMFS, and LRFFS for low- and high-risk groups were 97.7% versus 78.3% (hazard ratio [HR] = 0.2398; 95% confidence interval [CI]: 0.1277-0.4502; p < 0.0001), 91.1% versus 60.9% (HR = 0.3294; 95% CI: 0.2050-0.5292; p < 0.0001), 94.2% versus 68.7% (HR = 0.2413; 95% CI: 0.1284-0.4535; p < 0.0001) and 97.8% versus 77.9% (HR = 0.3078; 95% CI: 0.1700-0.5573; p = 0.0001), respectively. The maximal area under ROC curve of EBVCL+TVRR, EBVCL, TVRR, TNM stage, and RECIST 1.1 criteria for three-year OS was 0.829, 0.750, 0.711, 0.555, and 0.605, respectively.
CONCLUSION
The new-developed indicator (EBVCL+TVRR) could better predict the LANPC patient's survival after IC compared with TNM stage system or RECIST 1.1 criteria.
背景
探讨诱导化疗（IC）后联合因素 Epstein-Barr 病毒 DNA 变化水平（EBVCL）和肿瘤体积缩小率（TVRR）对局部晚期鼻咽癌（LANPC）预后的预测能力。
方法
回顾性分析 2010 年至 2018 年 299 例 LANPC 患者。采用受试者工作特征（ROC）曲线分析获得最佳临界值。根据 EBVCL 和 TVRR 的最佳临界值，将患者分为低风险组和高风险组。采用 Kaplan-Meier 和 ROC 曲线分析验证新预测因子（EBVCL+TVRR）的预后能力。通过 ROC 曲线比较 EBVCL+TVRR、EBVCL、TVRR、TNM 分期和 RECIST 1.1 标准的预后价值。主要终点为总生存（OS）、无进展生存（PFS）、无远处转移生存（DMFS）和无局部区域失败生存（LRFFS）。
结果
ROC 曲线分析 TVRR 对 3 年生存率的影响，显示 OS、PFS 和 LRFFS 的最佳 TVRR 临界值分别为 32.72%、30.21%和 29.87%，DMFS 的最佳 TVRR 临界值为 29.87%。EBVCL 的最佳临界值为 OS 时为 127 拷贝/ml，PFS、DMFS 和 LRFFS 时为 87.7 拷贝/ml。低风险组和高风险组的 3 年 OS、PFS、DMFS 和 LRFFS 分别为 97.7%比 78.3%（风险比[HR]为 0.2398；95%置信区间[CI]：0.1277-0.4502；p<0.0001）、91.1%比 60.9%（HR 为 0.3294；95%CI：0.2050-0.5292；p<0.0001）、94.2%比 68.7%（HR 为 0.2413；95%CI：0.1284-0.4535；p<0.0001）和 97.8%比 77.9%（HR 为 0.3078；95%CI：0.1700-0.5573；p=0.0001）。EBVCL+TVRR、EBVCL、TVRR、TNM 分期和 RECIST 1.1 标准的最大 ROC 曲线下面积分别为 0.829、0.750、0.711、0.555 和 0.605 用于预测 3 年 OS。
结论
与 TNM 分期系统或 RECIST 1.1 标准相比，新开发的指标（EBVCL+TVRR）可更好地预测 IC 后 LANPC 患者的生存情况。
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