The present meta-analysis was conducted to evaluate the prognostic value of pre and post-Epstein Barr Virus (EBV) DNA load testing and to assess the clinical benefit of using this molecular approach in the prognosis for a better nasopharyngeal carcinoma (NPC) management. Relevant studies were searched in different database until May 2020. Patient´s outcomes overall survival (OS), disease free survival (DFS), progression-free survival (PFS), distant-metastasis-free survival (DMFS), and local-regional-failure-free survival (LRFS), hazard ratios (HRs) and 95% confidence intervals (CIs) were extracted from selected studies. The association of pre and post-EBV DNA load and survival outcomes was assessed using review manager and the pooled HRs with 95% CIs were calculated. Twenty-six eligible studies were included in this meta-analysis, with a total of 9966 patients. Pooled HRs showed that EBV DNA levels before and after treatment are significantly associated with survival outcomes, with HR (95% CI) of 2.09 [1.74, 2.51] for OS, 1.77 [1.19, 2.62] for DFS, 2.53 [2.18, 2.92] for DMFS, 1.78 [1.45, 2.19] for LRFS and 2.17 [1.91, 2.47] for PFS in pre-EBV DNA, and an HR (95%) of 4.52 [2.44, 8.36], 4.08 [2.38, 6.99], 5.59 [ 3.58, 8.71] and 8.88 [5.29, 14.90] for OS, DFS and PFS and DMFS in post-EBV DNA, respectively. High pre and post-EBV DNA levels were significantly associated with poor NPC patient´s survival outcomes; which clearly confirm the high interest to introduce viral EBV DNA load as a prognostic biomarker for NPC management.
The current study was designed to investigate the changes in the circulating Epstein–Barr virus DNA load (EBV DNA) at various time points before and after treatment and its clinical significance in nasopharyngeal carcinoma (NPC). A total of 142 patients with NPC were prospectively enrolled in this study. The plasma EBV DNA concentration was measured before and after treatment using qPCR. The prognostic values of the EBV DNA load were analyzed using the Kaplan–Meier and Cox regression tests. Following multivariate analysis, our data showed that high pre-EBV DNA loads were associated with significantly poorer distant metastasis free survival (DMFS) and progression free survival (PFS); detectable end-EBV DNA loads were associated with significantly worse loco-regional recurrence free survival (LRRFS) and PFS, and the detecTable 6 months-post-EBV DNA loads were associated with significantly poorer overall survival (OS), DMFS and PFS (p < 0.05). Additionally, combining the pre-EBV DNA load and the stage of the disease, our results showed that patients at stage III-IVA with a low pre-EBV DNA load had similar survival rates as patients at stage II with a low or high pre-EBV DNA load, but had better survival rates than those at stage III-IVA with a high pre-EBV DNA load. Taken together, we showed that the change of the EBV DNA load measured at several time points was more valuable than at any single time point for predicting patients’ survival for NPC. Furthermore, combining the pre-EBV DNA load and the TNM classification could help to formulate an improved prognostic model for this cancer.
Purpose: While nasopharyngeal carcinoma (NPC) management in Morocco is still based on conventional work-ups: a head and neck computed tomography (HN-CT), thoracic and abdominal CT and bone scan, the combination of HN magnetic resonance imaging (HN-MRI) and 2-Deoxy-2-[18F] fluoro-D-glucose positron emission tomography/computed tomography ([18F] FDG PET/CT) is now widely used in the diagnostic and follow-up of this malignancy.Methods: In this prospective study, [18F] FDG PET/CT and HN-MRI outcomes of 117 NPC patients diagnosed between January 2017 and December 2018 were investigated in order to assess their usefulness in routine management of Moroccan patients with NPC. The concordance between HN-MRI and [18F] FDG PET/CT in Tumor (T) and Nodal (N) classification was assessed and the association between [18F] FDG PET/CT metabolic parameters (Tumor- maximum standardized uptake value (T-SUV max), Nodal (N-SUV max), node-to-tumor SUV ratio (NTR) and distant metastasis (M-SUV max), TNM staging system, NPC stages and patient’s survival outcomes was evaluated. Results: Our results showed a moderate concordance between T-TEP and T-MRI categories with a Cohen kappa coefficient (k) at 0.45, and a mediocre concordance between N-TEP and N-MRI (k=0.3). Metabolic parameters of the [18F] FDG PET/CT were assessed; N-SUV max values were significantly higher in patients with advanced nodal involvement, with a mean of 7.4, 9.7 and 11.0 for patients with N1, N2 and N3 nodal categories, respectively (p<0.05). overall, N-SUV max, NTR were independent prognostic markers for overall survival and progression free survival in Moroccan NPC patients (p<0.05).Conclusion: Our findings provide additional evidence into the complementary roles of HN-MRI and [18F] FDG PET/CT in TNM and overall staging of NPC. To the best of our knowledge, this is the first Moroccan study to highlight N-SUV max and NTR derived from [18F] FDG-PET/CT as promising metabolic biomarkers for NPC prognosis.
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