Individualized concurrent chemotherapy by pretreatment plasma Epstein-Barr viral DNA in II-III stage nasopharyngeal carcinoma: A propensity score matching analysis using a large cohort
Individualized concurrent chemotherapy by pretreatment plasma Epstein-Barr viral DNA in II-III stage nasopharyngeal carcinoma: A propensity score matching analysis using a large cohort
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II-III期鼻咽癌中预处理血浆Epstein-Barr病毒DNA的个体化同步化疗：使用大队列的倾向评分匹配分析
DOI：
10.1002/cam4.2343
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发表时间：
2019-08-01
期刊：
影响因子：
4
通讯作者：
Tang, Lin-Quan
中科院分区：
文献类型：
--
作者：
Sun, Xue-Song;Chen, Wen-Hui;Tang, Lin-Quan
目的探讨调强放疗（IMRT）时代不同eb病毒（EBV） DNA水平鼻咽癌II-III期患者同步化疗（CCT）的治疗效果。方法共纳入2742例II-III期鼻咽癌患者。患者接受带/不带CCT的IMRT。总生存期（OS）是主要终点。采用受试者工作特征曲线确定基于OS的pre-DNA截止值。通过倾向评分匹配，探讨CCT在不同EBV DNA水平患者中的作用。结果在我们的队列中，EBV前DNA的临界值为1460拷贝/mL（曲线下面积[AUC] 0.695-0.769；敏感性0.766；特异性0.599）。EBV DNA水平高的患者在OS、无进展生存期（PFS）、局部无复发生存期（LRFS）和远端无转移生存期（DMFS）中生存率较差。在EBV DNA水平为bb0 1460拷贝/mL的患者中，与IMRT组相比，同步放化疗（CCRT）组获得了更高的3年OS。然而，CCRT和IMRT组在EBV DNA（1460拷贝/mL）患者中显示出相当的OS，而在低风险患者（EBV DNA水平）中不是独立的预后因素
Object To ascertain the treatment effect of concurrent chemotherapy (CCT) in stage II-III nasopharyngeal carcinoma (NPC) patients with different Epstein-Barr virus (EBV) DNA level in intensity-modulated radiotherapy (IMRT) era. Methods A total of 2742 patients diagnosed with stage II-III NPC were involved in this study. Patients received IMRT with/without CCT. Overall survival (OS) was the primary endpoint. Receiver operating characteristics curve was used to determine the cut-off value of pre-DNA based on OS. After propensity score matching, the role of CCT was explored in patients with different EBV DNA level. Results In our cohort, the cut-off value of pre EBV DNA was 1460 copies/mL (area under curve [AUC], 0.695-0.769; sensitivity, 0.766; specificity, 0.599). Patients with high EBV DNA level showed poor survival in OS, progression free survival (PFS), locoregional relapse-free survival (LRFS) and distant metastasis-free survival (DMFS). In patients with EBV DNA level >1460 copies/mL, the concurrent chemoradiotherapy (CCRT) group achieved higher 3-year OS compared with IMRT groups. However, the CCRT and IMRT groups showed comparable OS in patients with EBV DNA 1460 copies/mL), while not an independent prognostic factor among the low-risk patients (EBV DNA level