Plasma Epstein-Barr Virus DNA Load After Induction Chemotherapy Predicts Outcome in Locoregionally Advanced Nasopharyngeal Carcinoma

Sun

et al. 2020

Aging

Purpose: This study aimed to elucidate the optimal cumulative cisplatin dose (CCD) for concurrent chemoradiotherapy (CCRT) according to the post-induction chemotherapy (IC) plasma Epstein-Barr virus (EBV) DNA level. Results: EBV DNA was detected and undetected in 179 and 370 patients, respectively. Of the entire cohort, 73/549 (13.3%) patients received a total CCD ≥ 160 mg/m 2 and 476/549 (86.7%) patients, <160 mg/m 2. CCD enhancement was not associated with a survival benefit in patients with undetected EBV DNA after IC. However, among patients with post-IC detectable EBV DNA, higher 3-year PFS and locoregional relapse-free survival (LRFS) rates were observed in those who received a CCD ≥ 160 mg/m 2. Multivariate analysis also showed CCD was an independent prognostic factor for PFS and LRFS in patients with post-IC detectable EBV DNA. Conclusions: CCD enhancement was not associated with a survival benefit in patients with undetected EBV DNA after IC. However, among patients with post-IC detectable EBV DNA, those receiving ≥160 mg/m 2 CCD showed significantly improved 3-year PFS and LRFS. Methods: NPC patients (549) treated with IC and CCRT were included. Prognosis was assessed using a multivariate Cox proportional hazards model. Furthermore, grade 1-4 toxicities were compared between different CCD groups.

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Optimal cumulative cisplatin dose in nasopharyngeal carcinoma patients based on plasma Epstein–Barr virus DNA level after induction chemotherapy

Sun

et al. 2020

Aging

“…Multiple reports have shown that pre-and post-treatment plasma EBV DNA are prognostic factors for NPC progression and survival [5,[14][15][16][17][18], and these ndings are also con rmed in this study. However, these previous studies mainly focused on few time points, for example, pre-treatment and 3 months posttreatment [19].…”

Section: Discussionsupporting

confidence: 83%

“…Cell-free EBV DNA from NPC tumor cells can be detected in the plasma of NPC patients [5], and the plasma DNA load can re ect the tumor load and residual disease or subclinical metastases [6]. Therefore, EBV DNA is widely considered as a reliable biomarker for early screening, clinical staging, prognosis prediction, individualized treatment and follow-up monitoring in NPC [7][8][9][10][11][12][13].While multiple studies have reported that plasma EBV DNA could be used as a predictive marker for NPC prognosis [5,[14][15][16][17][18], however, these studies only measured plasma EBV DNA load at limited time points, such as pre-treatment and 3 months post-treatment. We suggested that a long-term monitoring of dynamic changes of plasma EBV DNA could improve its prognostic value in NPC.In a meta-analysis by Qu et al [19], plasma EBV DNA was measured primarily from day 1 to 3 months post-treatment.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Monitoring of Dynamic Changes in Plasma EBV DNA For Improved Prognosis Prediction of Nasopharyngeal Carcinoma

Chen

Liang

et al. 2020

Preprint

Background: This study was performed to investigate whether long-term monitoring of dynamic changes in plasma Epstein-Barr virus (EBV) DNA could improve prognosis prediction of nasopharyngeal carcinoma (NPC).Methods: 1077 non-metastatic NPC patients were recruited to retrospectively analyze the prognostic value of plasma EBV DNA load pre-treatment and 3, 12, 24, and 36 months post-treatment. We also examined the prognostic value of dynamic changes in plasma EBV DNA at various time points.Results: Patients with plasma EBV DNA load above optimal pre- and post-treatment cut-offs had significantly worse five-year progression-free survival, distant metastasis-free survival, locoregional relapse-free survival, and overall survival(OS) at all time points, excluding only OS at 36 months post-treatment due to limited mortalities. Patients with persistently undetectable plasma EBV DNA at the first four time points had the best prognosis, followed by those with positive detection pre-treatment and consistently negative detection post-treatment, those with negative detection pre-treatment and positive detection at one time point post-treatment, and those with positive detection pre-treatment and at one time point post-treatment, whereas patients with positive detection at ≥2 time points post-treatment had the worst prognosis. Cox proportional hazard models identified the dynamic change pattern as an independent prognostic factor, and ROC curve analysis demonstrated that the dynamic change at four time point was more valuable than any single time point for predicting disease progression, distant metastasis, locoregional relapse, and mortality.Conclusions: Dynamic changes in plasma EBV DNA pre- and post-treatment could predict the long-term survival outcome and provide accurate risk stratification in NPC.

“…3,4 Regardless of the tumour biological heterogeneity, the anatomy-based tumour-node-metastasis (TNM) staging system is a widely used tool for predicting clinical outcomes or treatment benefits. 5 Additionally, other specific biological markers, such as Epstein-Barr virus (EBV) DNA 6,7 and serum lactate dehydrogenase (LDH) levels, 8,9 have been found to provide additional prognostic information for NPC patients.…”

Section: Introductionmentioning

confidence: 99%

Serum Calcium Levels Before Antitumour Therapy Predict Clinical Outcomes in Patients with Nasopharyngeal Carcinoma

Huang¹,

Yang²,

Tan³

et al. 2020

OTT

Purpose The prognostic value of serum calcium levels in nasopharyngeal carcinoma (NPC) remains unknown. This study aimed to evaluate the prognostic value of serum calcium levels in patients with NPC. Patients and Methods A total of 2094 patients diagnosed with NPC between April 2009 and September 2012 were enrolled in this retrospective analysis. The median follow-up time was 96.3 months (range: 4.1–120.0 months). Univariate and multivariable Cox proportional hazards models were used to identify significant and independent prognostic predictors of overall survival (OS), disease-free survival (DFS), distant metastasis-free survival (DMFS), and relapse-free survival (RFS). Results Overall, low serum calcium levels were detected in 1109/2094 (53.00%) patients and tended to be more frequently detected in older ( P <0.001) and female ( P =0.001) patients. Patients with low serum calcium levels had poorer OS ( P =0.011), DFS ( P =0.012) and DMFS ( P =0.004) than those with high serum calcium levels, but serum calcium levels had no significant effect on RFS ( P =0.376). In univariate and multivariable analyses, low serum calcium levels were a statistically significant and independent prognostic factor for OS, DFS, and DMFS but had no prognostic value for RFS. Conclusion Serum calcium levels can serve as a prognostic predictor and guide more individualized treatment for NPC patients.