Is pretreatment Epstein-Barr virus DNA still associated with 6-year survival outcomes in locoregionally advanced nasopharyngeal carcinoma?

Abstract

Purpose: The objective of this study was to confirm the association between pretreatment Epstein-Barr virus (EBV) DNA (pre-DNA) load and survival outcomes after long-term follow-up in patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC).Materials and Methods: Between November 2009 and February 2012, a total of 1036 patients with LA-NPC were enrolled. There were 762 patients in stage III and 274 in stage IVA-B. All patients were treated with radical radiotherapy with or without chemotherapy, and pre-DNA concentrations were quantified by a polymerase chain reaction assay. Patient outcomes were evaluated.Results: The 5-year overall survival (OS), distant metastasis-free surviva (DMFS), locoregional relapse-free survival (LRFS), and progression-free survival (PFS) rates were 84.7%, 87.0%, 90.2%, and 77.1%, respectively. By using previously defined pre-DNA cutoff value (1500 copies/ml pretreatment), pre-DNA was an independent prognostic predictor for OS, DMFS, and PFS using log-rank test. Multivariate Cox analysis also confirmed these results. Subgroup analysis indicated that the 5-year OS, DMFS, and PFS rates in patients staged IVA-B with pre-DNA < 1500 copies/ml were similar to those patients staged III with pre-DNA ≥ 1500 copies/ml, whereas patients staged IVA-B patients with pre-DNA ≥ 1500 copies/ml predicted worse outcome.Conclusions: In this expanded study, the prognostic significance of pre-DNA was confirmed using predefined cutoff value in an independent patient group, and pre-DNA was identified as an independent prognostic marker for the risk stratification in LA-NPC.

Clinical characteristics and survival outcomes of ascending, descending and mixed types of nasopharyngeal carcinoma in the non‐endemic areas of china: A propensity score matching analysis

“…EBV is a particularly sensitive indicator of lymph node metastasis in NPC. In the endemic areas of China, positive EBV accounts for the vast majority 8,14,15 . Of interest though, in our available data, most patients with NPC had a negative EBV result.…”

“…In the endemic areas of China, positive EBV accounts for the vast majority. 8,14,15 Of interest though, in our available data, most patients with NPC had a negative EBV result. It has been reported in numerous studies that the incidence of EBV-associated NPC appears to be related geographically 1,15,16 .…”

Clinical and survival analysis of nasopharyngeal carcinoma with consistently negative Epstein–Barr virus DNA

“…Previously reported studies confirmed that EBV DNA level before, during and after treatment all are significant predictors of clinical outcomes in NPC patients 16‐20 . But the clinical features and prognostic value of consistently negative EBV DNA status have rarely been studied.…”

Pretreatment Plasma EBV-DNA Load Guides Induction Chemotherapy Followed by Concurrent Chemoradiotherapy in Locoregionally Advanced Nasopharyngeal Cancer: A Meta-Analysis

“…Currently, anti-NPC regimens are adopted according to the sites of tumor invasion and TNM staging. However, tumor heterogeneity also affects the efficacy among patients at this stage ( 37 ). In addition, there are a number of studies on the prognostic value of plasma EBV-DNA levels in NPC.…”