Long-term outcomes of nasopharyngeal carcinoma by Epstein-Barr virus status in the Chinese population: a multicenter investigation

Abstract

Background: Because the vast majority of nasopharyngeal carcinoma (NPC) in Chinese patients is a direct result of Epstein–Barr virus (EBV) infection, there is a dearth of data for EBV-negative patients in this population. This multicenter study sought to examine the clinical characteristics of this population and compare long-term outcomes with a propensity-matched (1:1.5) EBV-positive cohort. Methods: NPC patients with known EBV status from four hospitals were collated (2013-2021). A logisticregression model was conducted to evaluate the relationship between patient characteristics and EBV status. The Kaplan–Meier method and Coxregression analysis were used to analyze survival data. Results: This study analyzed 48 (40%) EBV-negative and 72（60%）EBV-positive patients. The median follow-up time was 63.5 months. Most EBV-negative NPC patients (77.1%) were diagnosed in the advanced stages, and no significant prognostic factors were discerned in this subpopulation. EBV-negative disease was more associated with the keratinizing subtype (18.8% vs. 1.4%, P<0.05), whereas nearly all EBV-positive cases were non-keratinizing. Compared to EBV-negative NPC patients, EBV-positive NPC patients were more likely to develop local recurrence (9.7% vs. 0%, P=0.026). There was no statistical difference in mortality (8.3% vs. 4.2%, P=0.34) during the follow-up period. Conclusions: These multicenter data suggest that in the Chinese population, EBV-negative disease have similar survival outcomes as EBV-positive cases, despite the increased local recurrence in the latter. Further work is required to corroborate these conclusions. Trial registration: retrospectively registered (Permit Number: LLHBCH2022YN-037). This retrospective study followed the principles of the Helsinki Declaration and was approved by the Ethics Committee of Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China.