Plasma Epstein-Barr Virus DNA Load After Induction Chemotherapy Predicts Outcome in Locoregionally Advanced Nasopharyngeal Carcinoma
Plasma Epstein-Barr Virus DNA Load After Induction Chemotherapy Predicts Outcome in Locoregionally Advanced Nasopharyngeal Carcinoma
复制标题
诱导化疗后血浆 Epstein-Barr 病毒 DNA 载量可预测局部晚期鼻咽癌的结果。
DOI：
10.1016/j.ijrobp.2019.01.007
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发表时间：
2019-06-01
影响因子：
7
通讯作者：
Tang, Ling-Long
中科院分区：
文献类型：
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作者：
Huang, Cheng-Long;Sun, Zheng-Qiang;Tang, Ling-Long
目的：探讨诱导化疗(ICT)完成时血浆EB病毒(EBV)DNA载量(Post(ICT)-DNA)对局部晚期鼻咽癌(NPC)预后的预测作用，并比较其与放化疗后DNA(Post(RT)-DNA)的预后价值。方法：对278例III~IV期鼻咽癌患者行ICT联合同期CCRT治疗。结果：ICT后DNA与3年总生存率(86.4%vs.93.4%，P=.023)、无远处转移生存率(69.2%vs.93.9%，P<；.001)和无瘤生存率(64.6%vs.88.7%，P<；)显著相关；.001)，而不是(ICT)-DNA后无法检测到的。在多变量分析中，后DNA是总生存率(风险比[HR]，2.567；95%可信区间[CI]，1.104-5.967；P=.029)、无远处转移生存率(HR，5.618；95%CI，2.781-11.348；P<；.001)和无病生存率(HR，3.672；95%CI，2.064-6.533；P<；)的独立预测因子。001)。后(ICT)-DNA和后(RT)-DNA曲线下面积分别为0.584和0.561(P<；预测3年死亡；预测3年转移分别为0.717和0.649(P<；.001)；预测3年疾病失败分别为0.659和0.602(P<；.001)。结论：在ICT完成时，血浆EBVDNA载量是一个强大的、更早的预后预测指标，有助于进一步的风险分层和早期治疗改进。(C)2019 Elsevier Inc.保留所有权利。
Purpose: To investigate whether plasma Epstein-Barr virus (EBV) DNA load at induction chemotherapy (ICT) completion (post(ICT)-DNA) is a useful outcome predictor in locoregionally advanced nasopharyngeal carcinoma (NPC) and to compare the prognostic value of post(ICT)-DNA and postechemoradiation therapy (CCRT) DNA (post(RT)-DNA).Methods and Materials: We retrospectively reviewed 278 patients with stage III-IV NPC treated with ICT followed by concurrent CCRT. The EBV DNA load was measured by quantitative polymerase chain reaction pre-ICT (pre-DNA), at ICT completion (post(ICT)-DNA), and 1 week after CCRT completion (post(RT)-DNA).Results: Post(ICT)-DNA was associated with significantly worse 3-year overall survival (86.4% vs. 93.4%, P = .023), distant metastasisefree survival (69.2% vs. 93.9%, P < .001), and disease-free survival (64.6% vs. 88.7%, P < .001) than was undetectable post(ICT)-DNA. In multivariate analysis, post(ICT)-DNAwas an independent predictor of overall survival (hazard ratio [HR], 2.567; 95% confidence interval [CI], 1.104-5.967; P = .029), distant metastasisefree survival (HR, 5.618; 95% CI, 2.781-11.348; P < .001), and disease-free survival (HR, 3.672; 95% CI, 2.064-6.533; P < . 001). The post(ICT)-DNA and post(RT)-DNA areas under the curve were 0.584 and 0.561 (P < . 001), respectively, for predicting 3-year death; 0.717 and 0.649 (P < .001), respectively, for predicting 3-year metastasis; and 0.659 and 0.602 (P < .001), respectively, for predicting 3-year disease failure.Conclusions: Plasma EBV DNA load at ICT completion is a powerful and earlier outcome predictor in locoregionally advanced NPC that would facilitate further risk stratification and early treatment modification. (C) 2019 Elsevier Inc. All rights reserved.