Xiong Yudi, Yuan Mengting, Liu Zhigang, Huang Jing, Bi Jianping, Pi Guoliang, Li Ying, Li Yanping, He Hanping, Verma Vivek, Tian Suqing, Han Guang
Department of Radiation Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430060, China.
Department of Oncology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai 519000, China.
J Clin Med. 2023 Apr 20;12(8):3005. doi: 10.3390/jcm12083005.
Because the vast majority of nasopharyngeal carcinoma (NPC) in Chinese patients is a direct result of Epstein-Barr virus (EBV) infection, there is a dearth of data for EBV-negative patients in this population. This multicenter study sought to examine the clinical characteristics of EBV-negative patients and compare long-term outcomes with a propensity-matched (1:1.5) EBV-positive cohort. NPC patients with known EBV status from four hospitals were collated (2013-2021). A logistic regression model was conducted to evaluate the relationship between patient characteristics and EBV status. The Kaplan-Meier method and Cox regression analysis were used to analyze survival data. This study analyzed 48 (40%) EBV-negative and 72 (60%) EBV-positive patients. The median follow-up time was 63.5 months. Most EBV-negative NPC patients (77.1%) were diagnosed in advanced stages with a higher rate (87.5%) of positive lymph node disease, and no significant prognostic factors were discerned in this subpopulation. The EBV-negative disease was more associated with the keratinizing subtype (18.8% vs. 1.4%, < 0.05). Compared to EBV-negative NPC patients, EBV-positive NPC patients were more likely to develop a local recurrence (9.7% vs. 0%, = 0.026). There was no statistical difference in mortality (EBV-negative vs. EBV- positive, 8.3% vs. 4.2%, = 0.34) during the follow-up period. Although the median PFS and median OS were not reached, the 3-year PFS rate was 68.8% vs. 70.8% (EBV-negative vs. EBV-positive, = 0.06), the 3-year OS rate was 70.8% vs. 76.4% (EBV-negative vs. EBV-positive, = 0.464), the 5-year PFS rate was 56.3% vs. 50% (EBV-negative vs. EBV-positive, = 0.451), and the 5-year OS rate was 56.3% vs. 58.3% (EBV-negative vs. EBV-positive, = 0.051), respectively. These data show that EBV-positive NPC patients seem to have a tendency to gain better survival compared with EBV-negative NPC patients. Most of the EBV-negative patients were in the middle and late stages at the time of diagnosis and were more associated with the keratinizing subtype. EBV status may be associated with prognosis in NPC. EBV positivity seems to be associated with better survival in NPC patients. Still, due to the small cohort of patients and the short observation period for a number of patients, further work is required to corroborate these conclusions.
由于中国患者中绝大多数鼻咽癌（NPC）是由爱泼斯坦-巴尔病毒（EBV）感染直接导致的，该人群中EBV阴性患者的数据匮乏。这项多中心研究旨在检查EBV阴性患者的临床特征，并将长期结果与倾向匹配（1:1.5）的EBV阳性队列进行比较。整理了四家医院已知EBV状态的NPC患者（2013 - 2021年）。进行逻辑回归模型以评估患者特征与EBV状态之间的关系。采用Kaplan-Meier方法和Cox回归分析来分析生存数据。本研究分析了48例（40%）EBV阴性和72例（60%）EBV阳性患者。中位随访时间为63.5个月。大多数EBV阴性NPC患者（77.1%）在晚期被诊断出来，淋巴结疾病阳性率较高（87.5%），并且在该亚组中未发现显著的预后因素。EBV阴性疾病与角化型的相关性更高（18.8%对1.4%，<0.05）。与EBV阴性NPC患者相比，EBV阳性NPC患者更有可能发生局部复发（9.7%对0%，P = 0.026）。随访期间死亡率无统计学差异（EBV阴性对EBV阳性，8.3%对4.2%，P = 0.34）。尽管未达到中位无进展生存期（PFS）和中位总生存期（OS），但3年PFS率为68.8%对70.8%（EBV阴性对EBV阳性，P = 0.06），3年OS率为70.8%对76.4%（EBV阴性对EBV阳性，P = 0.464），5年PFS率为56.3%对50%（EBV阴性对EBV阳性，P = 0.451），5年OS率为56.3%对58.3%（EBV阴性对EBV阳性，P = 0.051）。这些数据表明，与EBV阴性NPC患者相比，EBV阳性NPC患者似乎有获得更好生存的趋势。大多数EBV阴性患者在诊断时处于中晚期，并且与角化型的相关性更高。EBV状态可能与NPC的预后相关。EBV阳性似乎与NPC患者更好的生存相关。然而，由于患者队列较小且部分患者观察期较短，需要进一步开展工作来证实这些结论。
