Comparison of clinical and molecular surveillance in patients with advanced nasopharyngeal carcinoma after primary therapy - The potential role of quantitative analysis of circulating Epstein-Barr virus DNA
Comparison of clinical and molecular surveillance in patients with advanced nasopharyngeal carcinoma after primary therapy - The potential role of quantitative analysis of circulating Epstein-Barr virus DNA
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作者：
Hong, RL;Lin, CY;Hsu, MM
背景。在恶性肿瘤患者早期发现复发的重要性是公认的。鼻咽癌（NPC）患者可检测到循环eb病毒（EBV） DNA。本研究的目的是评估血浆EBV DNA监测在鼻咽癌复发早期检测中的有效性，并与传统方法进行比较。两项前瞻性临床试验中有局部复发或远处转移的鼻咽癌患者被纳入研究。对这些患者的临床资料进行了仔细检查，以寻找复发的证据。采用实时定量聚合酶链式反应（pcr）方法对前瞻性采集的血浆样品中EBV DNA拷贝数进行回顾性分析。在临床复发时，26例局部复发患者中65%和28例远处衰竭患者中除1例外，其余均有循环EBV DNA。局部复发患者治疗结束至循环EBV DNA阳性时间与治疗结束至首次观察到临床异常时间的差异无统计学意义（P = 0.84）。然而，在远处转移的患者中，首次检测到循环EBV DNA的时间明显较短（P < 0.0001）。Kaplan-Meier估计到血浆EBV DNA出现的中位时间为190天，95%可信区间（CI）为95-300天，到首次观察到临床异常的中位时间为295天（95% CI， 276-361天）。监测血浆EBV DNA水平在鼻咽癌患者远处衰竭的早期检测方面优于传统方法。这项技术的作用应该在前瞻性研究中进行评估，并纳入补充的先进成像技术。(C) 2004年美国癌症协会。
BACKGROUND. The importance of detecting recurrence at an early stage in patients with malignant disease is well recognized. Circulating Epstein-Barr virus (EBV) DNA can be detected in patients with nasopharyngeal carcinoma (NPC). The objective of the current study was to assess the effectiveness of plasma EBV DNA monitoring in the early detection of NPC recurrence compared with conventional methods.METHODS. Patients with NPC in two prospective clinical trials who had locoregional recurrences or distant metastases were recruited into the study. Clinical data on these patients were scrutinized for evidence of recurrence. EBV DNA copy numbers in the prospectively collected plasma samples were assayed retrospectively with real-time quantitative polymerase chain reaction analysis.RESULTS. At the time of clinical recurrence, 65% of 26 patients with locoregional recurrences and all but 1 of 28 patients with distant failure had circulating EBV DNA. The difference between the time from completion of treatment to positivity for circulating EBV DNA and the time from completion of treatment to the first observed clinical abnormality was not statistically significant for patients with local recurrence (P = 0.84). However, the time to the first detection of circulating EBV DNA was significantly shorter among patients with distant metastases (P < 0.0001). The Kaplan-Meier estimated median time to the emergence of plasma EBV DNA was 190 days, with a 95% confidence interval (CI) of 95-300 days, and the median time to the first observed clinical abnormality was 295 days (95% CI, 276-361 days).CONCLUSIONS. Monitoring plasma EBV DNA levels surpassed traditional methods for the early detection of distant failure in patients with NPC. The role of this technique should be evaluated in prospective studies that incorporate complementary advanced imaging technology. (C) 2004 American Cancer Society.