Individualized induction chemotherapy by pre-treatment plasma Epstein-Barr viral DNA in advanced nasopharyngeal carcinoma
Individualized induction chemotherapy by pre-treatment plasma Epstein-Barr viral DNA in advanced nasopharyngeal carcinoma
复制标题
治疗前血浆 Epstein-Barr 病毒 DNA 个体化诱导化疗治疗晚期鼻咽癌
DOI：
10.1186/s12885-018-5177-9
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发表时间：
2018-12-19
期刊：
影响因子：
3.8
通讯作者：
Ma, Jun
中科院分区：
文献类型：
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作者：
Zhang, Jian;Peng, Hao;Ma, Jun
背景Epstein-Barr病毒DNA预处理（pre-DNA）在局部区域晚期鼻咽癌个体化诱导化疗（IC）中的作用尚不清楚。我们的目标是解决这个临床问题。方法回顾性分析6218例新诊断的LA-NPC同步放化疗（CCRT）伴或不伴IC的资料。采用受试者工作特征（Receiver operating characteristic， ROC）曲线计算基于无病生存（disease-free survival， DFS）的pre-DNA截止值。采用倾向评分匹配（PSM）方法平衡预后因素，匹配患者。比较IC + CCRT组和CCRT组的生存结局。结果在原始队列中，IC + CCRT组与CCRT组的生存率无差异。pre-DNA的截止值为4650 copies/ml（曲线下面积[AUC] 0.620，灵敏度0.6224，特异性0.5673）。对于Pre-DNA≤4650拷贝/ml的患者，IC + CCRT和CCRT组也获得了相当的生存结果（所有比率的P < 0.05）。然而，IC + CCRT与3年DFS （78.6% vs. 74.8%，P= 0.03）、总生存率（OS; 91.4% vs. 87.5%，P= 0.002）和远端无转移生存率（DMFS; 86.0% vs. 82.2%，P= 0.036）的显著改善相关。多因素分析也证实IC + CCRT是DFS （HR, 0.817, 95% CI, 0.683-0.977， P= 0.027）、OS （HR, 0.675, 95% CI, 0.537-0.848， P= 0.001）和DMFS （HR, 0.782, 95% CI, 0.626-0.976， P= 0.03）的独立预后因素。结论除了LA-NPC的其他基线临床特征外，spre - dna可能是个体化IC的可行和有力的考虑因素。
BackgroundThe role of pretreatment Epstein-Barr virus DNA (pre-DNA) for individualized induction chemotherapy (IC) in locoregionally advanced nasopharyngeal carcinoma (LA-NPC) still remains unknown. We aimed to address this clinical issue.MethodsIn total, data on 6218 patient with newly diagnosed LA-NPC receiving concurrent chemoradiotherapy (CCRT) with or without IC were retrospectively reviewed. Receiver operating characteristics (ROC) curve was adopted to calculate the cut-off value of pre-DNA based on disease-free survival (DFS). Propensity score matching (PSM) method was adopted to balance prognostic factors and match patients. Survival outcomes between IC + CCRT and CCRT groups were compared.ResultsAmong the original cohort, no survival difference between IC + CCRT and CCRT groups was found. The cut-off value of pre-DNA was 4650 copies/ml (area under curve [AUC], 0.620; sensitivity, 0.6224; specificity, 0.5673). For patients with Pre-DNA ≤ 4650 copies/ml, the IC + CCRT and CCRT groups also achieved comparable survival outcomes (P> 0.05 for all rates). However, IC + CCRT was associated with significantly improved 3-year DFS (78.6% vs. 74.8%,P= 0.03), overall survival (OS; 91.4% vs. 87.5%,P= 0.002) and distant metastasis-free survival (DMFS; 86.0% vs. 82.2%,P= 0.036) for patient with pre-DNA > 4650 copies/ml. Multivariate analysis also confirm that IC + CCRT was an independent prognostic factor for DFS (HR, 0.817; 95% CI, 0.683–0.977;P= 0.027), OS (HR, 0.675; 95% CI, 0.537–0.848;P= 0.001) and DMFS (HR, 0.782; 95% CI, 0.626–0.976;P= 0.03).ConclusionsPre-DNA may be a feasible and powerful consideration for individualized IC apart from other baseline clinical characteristics in LA-NPC.