Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People's Republic of China.
Department of Head and Neck Oncology, Department of Radiation Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
Cancer Med. 2023 Jul;12(14):14979-14987. doi: 10.1002/cam4.6132. Epub 2023 May 22.
To assess the prognostic effect of plasma Epstein-Barr virus (EBV) DNA load after induction chemotherapy (post -EBV DNA) on survival outcomes in locoregionally advanced nasopharyngeal carcinoma (LA-NPC).
Patients who were diagnosed with LA-NPC between August 2017 and October 2021 were included. The chi-squared test, receiver operating characteristic, Kaplan-Meier survival analysis, and Cox proportional hazard model were used for statistical analysis.
We included 172 patients with EBV DNA-positive LA-NPC in this study. There were 35.5% (n = 61) of patients had plasma residual EBV DNA after induction chemotherapy (IC). Patients with higher EBV DNA before IC (p < 0.001) and advanced nodal stage (p = 0.031) were significantly related to a higher rate of residual post -EBV DNA. Patients with detectable post -EBV DNA had inferior 3-year locoregional relapse-free survival (LRFS) (86.7% vs. 96.9%, p = 0.020), distant metastasis-free survival (DMFS) (76.8% vs. 94.2%, p < 0.001), disease-free survival (DFS) (68.2% vs. 91.1%, p < 0.001), and overall survival (OS) (87.8% vs. 97.9%, p = 0.044) compared to those with undetectable post -EBV DNA. The multivariate prognostic analyses showed that detectable post -EBV DNA was the independent prognostic factor related to LRFS (p = 0.032), DMFS (p = 0.010), and DFS (p = 0.004) than those with undetectable post -EBV DNA. Pretreatment EBV DNA load had no prognostic effect in the multivariate analyses.
The monitoring of plasma post -EBV DNA has improved prognostication in LA-NPC. Our findings suggest that post -EBV DNA may be a robust indicator to identify the optimal candidate for intensive treatment.
评估诱导化疗后血浆 Epstein-Barr 病毒 (EBV) DNA 载量（post-EBV DNA）对局部晚期鼻咽癌 (LA-NPC) 患者生存结局的预后影响。
纳入 2017 年 8 月至 2021 年 10 月期间诊断为 LA-NPC 的患者。采用卡方检验、受试者工作特征曲线、Kaplan-Meier 生存分析和 Cox 比例风险模型进行统计学分析。
本研究共纳入 172 例 EBV DNA 阳性 LA-NPC 患者，诱导化疗后（IC）有 35.5%（n=61）患者的血浆 EBV DNA 残留。IC 前 EBV DNA 水平较高（p<0.001）和淋巴结分期较晚（p=0.031）的患者，其 post-EBV DNA 残留率较高。可检测到 post-EBV DNA 的患者的 3 年局部无复发生存率（LRFS）（86.7% vs. 96.9%，p=0.020）、无远处转移生存率（DMFS）（76.8% vs. 94.2%，p<0.001）、无病生存率（DFS）（68.2% vs. 91.1%，p<0.001）和总生存率（OS）（87.8% vs. 97.9%，p=0.044）均低于不可检测到 post-EBV DNA 的患者。多变量预后分析显示，与不可检测到 post-EBV DNA 的患者相比，可检测到 post-EBV DNA 是与 LRFS（p=0.032）、DMFS（p=0.010）和 DFS（p=0.004）相关的独立预后因素。治疗前 EBV DNA 载量在多变量分析中无预后意义。
监测血浆 post-EBV DNA 可改善 LA-NPC 的预后。我们的研究结果表明，post-EBV DNA 可能是识别强化治疗最佳候选者的有力指标。
