联合预处理和中期治疗的爱泼斯坦-巴尔病毒DNA载量有助于鼻咽癌患者的预后评估和治疗调整。
Combined pre-treatment and middle-treatment Epstein-Barr virus DNA load contributes to prognostication and treatment modification in nasopharyngeal carcinoma patients.
作者信息
Lan Kaiqi, Mao Jingrong, Sun Xuesong, Li Suchen, Xie Siyi, Sun Rui, Liu Sailan, Mai Haiqiang
机构信息
Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Provincial Clinical Research Center for Cancer, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.
Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China.
出版信息
Ther Adv Med Oncol. 2024 Jan 6;16:17588359231221343. doi: 10.1177/17588359231221343. eCollection 2024.
OBJECTIVE
To investigate whether pre-treatment and middle-treatment plasma Epstein-Barr virus (EBV) DNA loads are useful predictors of prognosis and indicators of therapy modification in nasopharyngeal carcinoma (NPC) patients undergoing radical concurrent chemoradiotherapy (CCRT).
METHODS
Plasma EBV DNA load was measured by quantitative polymerase chain reaction before treatment (pre-DNA) and during the second cycle of DDP (mid-DNA). The primary endpoint was 5-year progression-free survival (PFS).
RESULTS
A total of 775 NPC patients treated with CCRT were included. In total, 553 patients with pre-DNA <4000 copies/mL and 222 with ⩾4000 copies/mL. A total of 559 patients had mid-DNA undetectable and 216 had detectable. Multivariate analysis showed that pre- and mid-DNA were independent prognostic predictors of PFS [hazard ratio (HR), 2.035; 95% confidence interval (CI), 1.406-2.944; < 0.001; HR, 1.597; 95% CI, 1.101-2.316; = 0.014]. The area under the curve of the combination of pre-DNA and mid-DNA for 5-year PFS was higher than that of pre-DNA, mid-DNA, and tumor node metastasis (TNM) stage (0.679 0.622, 0.608, 0.601). In the low-risk group (pre-DNA <4000 copies/mL and undetectable mid-DNA), patients receiving ⩽200 mg/m showed similar efficacy as those receiving >200 mg/m cumulative cisplatin dose (CCD) but were associated with fewer all-grade late toxicities. However, in the high-risk group (pre-DNA ⩾4000 copies/mL or detectable mid-DNA), patients receiving >200 mg/m CCD showed a higher 5-year PFS (73.1% 58.6%, = 0.027) and locoregional relapse-free survival (88.5% 76.1%, = 0.028) than those receiving ⩽200 mg/m CCD.
CONCLUSION
The combination of pre-DNA and mid-DNA could be particularly useful for guiding risk stratification and early treatment modification for NPC treated with CCRT. A total of 200 mg/m cisplatin seemed to be the optimal dose for the low-risk patients, while >200 mg/m cisplatin may be adequate to achieve satisfactory survival outcomes in the high-risk group.
目的
探讨在接受根治性同步放化疗（CCRT）的鼻咽癌（NPC）患者中，治疗前和治疗中期血浆 Epstein-Barr 病毒（EBV）DNA 载量是否为预后的有用预测指标及治疗调整的指标。
方法
在治疗前（pre-DNA）和顺铂（DDP）第二个周期期间（mid-DNA），通过定量聚合酶链反应测量血浆 EBV DNA 载量。主要终点为 5 年无进展生存期（PFS）。
结果
共纳入 775 例接受 CCRT 治疗的 NPC 患者。其中，553 例患者 pre-DNA<4000 拷贝/mL，222 例患者 pre-DNA≥4000 拷贝/mL。共有 559 例患者 mid-DNA 检测不到，216 例患者 mid-DNA 可检测到。多因素分析显示，pre-DNA 和 mid-DNA 是 PFS 的独立预后预测指标[风险比（HR），2.035；95%置信区间（CI），1.406 - 2.944；P<0.001；HR，1.597；95%CI，1.101 - 2.316；P = 0.014]。pre-DNA 和 mid-DNA 联合用于 5 年 PFS 的曲线下面积高于 pre-DNA、mid-DNA 和肿瘤淋巴结转移（TNM）分期（0.679 对 0.622、0.608、0.601）。在低风险组（pre-DNA<4000 拷贝/mL 且 mid-DNA 检测不到）中，接受≤200mg/m²顺铂累积剂量（CCD）的患者与接受>200mg/m²CCD 的患者疗效相似，但全级别的晚期毒性反应较少。然而，在高风险组（pre-DNA≥4000 拷贝/mL 或 mid-DNA 可检测到）中，接受>200mg/m²CCD 的患者 5 年 PFS（73.1%对 58.6%，P = 0.027）和局部区域无复发生存率（88.5%对 76.1%，P = 0.028）高于接受≤200mg/m²CCD 的患者。
结论
pre-DNA 和 mid-DNA 的联合对于指导接受 CCRT 治疗的 NPC 患者的风险分层和早期治疗调整可能特别有用。200mg/m²顺铂似乎是低风险患者的最佳剂量，而>200mg/m²顺铂可能足以在高风险组中实现满意的生存结果。
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