The Prognostic Value of Plasma Epstein-Barr Viral DNA and Tumor Response to Neoadjuvant Chemotherapy in Advanced-Stage Nasopharyngeal Carcinoma
The Prognostic Value of Plasma Epstein-Barr Viral DNA and Tumor Response to Neoadjuvant Chemotherapy in Advanced-Stage Nasopharyngeal Carcinoma
复制标题
血浆 Epstein-Barr 病毒 DNA 和晚期鼻咽癌新辅助化疗肿瘤反应的预后价值
DOI：
10.1016/j.ijrobp.2015.08.003
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发表时间：
2015-11-15
影响因子：
7
通讯作者：
Mai, Hai-Qiang
中科院分区：
文献类型：
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作者：
Liu, Li-Ting;Tang, Lin-Quan;Mai, Hai-Qiang
目的：目的探讨血浆EB病毒（EBV）DNA载量和新辅助化疗（NACT）对晚期鼻咽癌（NPC）患者的预后价值。方法：前瞻性研究185例III期至IVb期NPC患者，采用NACT联合同步放化疗（CCRT）治疗。主要终点为无进展生存期（PFS），次要终点为局部无复发生存期（LRFS）和无远处转移生存期（DMFS）。结果：治疗前165例（89%）患者检测到EBV DNA，治疗后127例（69%）患者未检测到EBV DNA。NACT后可检测到的EBV DNA水平与不良预后相关（3年PFS 71.8% vs 85.2%，P = 0.008和3年DMFS 82.5% vs 92.3%，P = 0.013）。NACT治疗后不满意的肿瘤缓解（疾病稳定或疾病进展）也与不良临床结局相关（3年PFS为71.1% vs 85.9%，P = 0.005，3年LRFS为82.7% vs 93.5%，P = 0.012）。多变量分析显示，NACT后的EBV DNA水平（风险比[HR] 2.31，95% CI 1.18-4.54，P = 0.015）和NACT后的肿瘤缓解（HR 2.84，95% CI 1.42-5.67，P = 0.003）均为PFS的显著预后因素。多因素分析也显示NACT后EBV DNA是DMFS唯一显著的预测因子（HR 2.99，95% CI 1.25-7.15，P = 0.014），NACT的肿瘤缓解是LRFS的唯一显著预测因素（HR 3.31，95% CI 1.21-9.07，P = 0.020）。可检测的EBV DNA水平和不令人满意的肿瘤反应NACT后的病情稳定或病情进展可作为晚期NPC患者预后不良的预测指标。这些发现将有助于在CCRT前进行进一步的风险分层、早期治疗调整或两者兼而有之。(C)2015 Elsevier Inc. All rights reserved.
Purpose: 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 relapseefree survival (LRFS) and distant metastasisefree 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. (C) 2015 Elsevier Inc. All rights reserved.