Risk stratification for nasopharyngeal carcinoma: a real-world study based on locoregional extension patterns and Epstein-Barr virus DNA load

Abstract

Aim: The present study aimed to evaluate the combined value of locoregional extension patterns (LEPs) and circulating cell-free Epstein–Barr virus (cf EBV) DNA for risk stratification of locoregionally advanced nasopharyngeal carcinoma (LA-NPC) to better guide therapeutic strategies. Methods: A total of 7227 cases of LA-NPC were reviewed retrospectively and classified into six groups according to their LEP (ascending, descending, or mixed type) and pre-treatment cf EBV-DNA load (⩾ versus <4000 copy/ml). Using a supervised statistical clustering approach, patients in the six groups were clustered into low, intermediate, and high-risk clusters. Progression-free survival (PFS), overall survival (OS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRRFS) were calculated using the Kaplan–Meier method and differences were compared using the log-rank test. Results: Survival curves for the low, intermediate, and high-risk clusters were significantly different for all endpoints. The 5-year survival rate for the low, intermediate, and high-risk clusters, respectively, were: PFS (83.5%, 73.2%, 62.6%, p < 0.001), OS (91.0%, 82.7%, 73.2%, p < 0.001), DMFS (92.3%, 83.0%, 73.4%, p < 0.001), and LRRFS (91.0%, 88.0%, 83.3%, p < 0.001). The risk clusters acted as independent prognostic factors for all endpoints. Among the patients in the high-risk cluster, neoadjuvant chemotherapy combined with concurrent chemoradiotherapy (CCRT) significantly improved the patients 5-year PFS (66.4% versus 57.9%, p = 0.014), OS (77.6% versus 68.6%; p < 0.002), and DMFS (76.6% versus 70.6%; p = 0.028) compared with those treated with CCRT. Conclusion: Our results could facilitate the development of risk-stratification and risk-adapted therapeutic strategies for patients with LA-NPC.

Prognostic Value of Plasma Epstein-Barr Virus DNA Levels Pre- and Post-Neoadjuvant Chemotherapy in Patients With Nasopharyngeal Carcinoma

“…The predictive ability of the nomograms of the circulating EBV DNA levels is higher than that of nomograms of the TNM stage (25). These findings suggest that plasma EBV DNA levels are useful in risk stratification and prognosis prediction in patients with NPC (23,26). Furthermore, evaluating the plasma EBV DNA levels may improve the prediction of the PFS and OS (27,28).…”

Residual Volume of Lymph Nodes During Chemoradiotherapy Based Nomogram to Predict Survival of Nasopharyngeal Carcinoma Patient Receiving Induction Chemotherapy

“…Based on results of several clinical randomized control studies, induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) has been recommended as a preferred regimen for locoregionally advanced NPC (LA-NPC) by guideline of National Comprehensive Cancer Network (NCCN) and Chinese Society of Clinical Oncology (CSCO) (2,3). Unfortunately, approximate 20-30% patients could not benefit from IC-CCRT regime, and the toxicities were increased compared with CCRT (4,5). Therefore, it's important to identify the patients who could benefit from IC followed by CCRT (4)(5)(6)(7)(8).…”

“…Unfortunately, approximate 20-30% patients could not benefit from IC-CCRT regime, and the toxicities were increased compared with CCRT (4,5). Therefore, it's important to identify the patients who could benefit from IC followed by CCRT (4)(5)(6)(7)(8).…”

Cisplatin-based Concurrent Chemoradiotherapy Improved the Survival of Locoregionally Advanced Nasopharyngeal Carcinoma After Induction Chemotherapy by Reducing Early Treatment Failure

“…Theoretically, EBV DNA could be released upon cancer cell apoptosis or necrosis [28][29][30]. The role of pretreatment EBV DNA load for clinical prognostication has been determined in recent years [31,32], which suggests that this biomarker contain crucial additional biological information regarding tumor intrinsic aggressiveness.…”