The Prognostic Value of Plasma Epstein-Barr Viral DNA and Tumor Response to Neoadjuvant Chemotherapy in Advanced-Stage Nasopharyngeal Carcinoma

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• 作者：Li-Ting Liu ; MD^&lowast ; ; ^&dagger ; ; Lin-Quan Tang ; MD ; PhD^&lowast ; ; ^&dagger ; ; Qiu-Yan Chen ; MD ; PhD^&lowast ; ; ^&dagger ; ; Lu Zhang ; MD^&lowast ; ; ^&dagger ; ; Shan-Shan Guo ; MD^&lowast ; ; ^&dagger ; ; Ling Guo ; MD ; PhD^&lowast ; ; ^&dagger ; ; Hao-Yuan Mo ; MD ; PhD^&lowast ; ; ^&dagger ; ; Chong Zhao ; MD ; PhD^&lowast ; ; ^&dagger ; ; Xiang Guo ; MD ; PhD^&lowast ; ; ^&dagger ; ; Ka-Jia Cao ; MD ; PhD^&lowast ; ; ^&dagger ; ; Chao-Nan Qian ; MD ; PhD^&lowast ; ; ^&dagger ; ; Mu-Sheng Zeng ; MD ; PhD^&lowast ; ; Jin-Xin Bei ; MD ; PhD^&lowast ; ; Ming-Huang Hong ; MD ; PhD^&lowast ; ; ^&Dagger ; ; Jian-Yong Shao ; MD ; PhD^&lowast ; ; ^§ ; ; Ying Sun ; MD ; PhD^&lowast ; ; ^‖ ; Jun Ma ; MD ; PhD^&lowast ; ; ^‖ ; Hai-Qiang Mai ; MD ; PhD^&lowast ; ; ^&dagger ; ; ^{maihq@sysucc.org.cn" class="auth_mail" title="E-mail the corresponding author}
• 刊名：International Journal of Radiation Oncology*Biology*Physics
• 出版年：2015
• 出版时间：15 November 2015
• 年：2015
• 卷：93
• 期：4
• 页码：862-869
• 全文大小：411 K

文摘

To explore the prognostic value of the plasma load of Epstein-Barr viral (EBV) DNA and the tumor response to neoadjuvant chemotherapy (NACT) in advanced-stage nasopharyngeal carcinoma (NPC).

Patients and Methods

In all, 185 consecutive patients with stage III to IVb NPC treated with NACT followed by concurrent chemoradiation therapy (CCRT) were prospectively enrolled. The primary endpoint was progression-free survival (PFS), and the secondary endpoints included locoregional relapse–free survival (LRFS) and distant metastasis–free survival (DMFS).

Results

EBV DNA was detected in 165 (89%) patients before treatment but was undetectable in 127 (69%) patients after NACT. Detectable EBV DNA levels after NACT were correlated with poor prognosis (3-year PFS 71.8% vs 85.2%, P=.008 and 3-year DMFS 82.5% vs 92.3%, P=.013). An unsatisfactory tumor response (stable disease or disease progression) after NACT was also correlated with poor clinical outcome (3-year PFS 71.1% vs 85.9%, P=.005 and 3-year LRFS 82.7% vs 93.5%, P=.012). Multivariate analysis showed that the EBV DNA level after NACT (hazard ratio [HR] 2.31, 95% CI 1.18-4.54, P=.015) and the tumor response to NACT (HR 2.84, 95% CI 1.42-5.67, P=.003) were both significant prognostic factors for PFS. Multivariate analysis also showed that EBV DNA after NACT was the only significant predictor of DMFS (HR 2.99, 95% CI 1.25-7.15, P=.014) and that tumor response to NACT was the only significant predictor of LRFS (HR 3.31, 95% CI 1.21-9.07, P=.020).

Conclusion

Detectable EBV DNA levels and an unsatisfactory tumor response (stable disease or disease progression) after NACT serve as predictors of poor prognosis for patients with advanced-stage NPC. These findings will facilitate further risk stratification, early treatment modification, or both before CCRT.