The diagnostic and prognostic values of plasma Epstein‐Barr virus DNA for residual cervical lymphadenopathy in nasopharyngeal carcinoma patients: a retrospective study

Abstract

Background Currently, the diagnosis and treatment of nasopharyngeal carcinoma (NPC) patients with residual cervical lymphadenopathy following radical radiotherapy with or without chemotherapy are challenging. We investigated the prognosis of NPC patients with residual cervical lymphadenopathy and assessed the diagnostic and prognostic values of Epstein-Barr virus (EBV) DNA in these patients. Methods This study included 82 NPC patients who were diagnosed with suspected residual cervical lymphadenopathy following completion of antitumor therapy. Their plasma EBV DNA levels were measured using quantitative polymerase chain reaction (qPCR) before the initiation of treatment and before neck dissection. Fine needle aspiration cytology (FNAC) was performed in 21 patients. All patients had undergone neck dissection and postoperative pathological examination to identify the nature of residual cervical lymphadenopathy. The overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRRFS) were calculated using the Kaplan–Meier method and compared using the log-rank test. The Cox proportional hazards model was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Multivariable analysis was used to estimate the effect of potential prognostic factors on survival. Results Following a median follow-up of 52.6 months, compared with patients with negative postoperative pathological findings for residual cervical lymphadenopathy, the patients with positive findings had a significantly lower 3-year PFS rate (49.9% vs. 83.3%, P = 0.008). Among NPC patients with residual cervical lymphadenopathy, the patients with preoperative plasma EBV DNA > 0 copy/mL had a lower 3-year PFS rate than did those with no detectable EBV DNA (43.7% vs. 61.1%, P = 0.031). In addition, combining FNAC with preoperative EBV DNA detection improved the diagnostic sensitivity. Multivariable analysis demonstrated that residual cervical lymphadenopathy with positive postoperative pathological result was an independent prognostic factor for PFS and that detectable preoperative plasma EBV DNA was an independent prognostic factor for OS. Conclusions Using FNAC combined with preoperative EBV DNA detection improves the sensitivity in diagnosing NPC with residual cervical lymphadenopathy. Compared with patients with undetectable EBV DNA, patients with detectable preoperative plasma EBV DNA have worse prognosis and may require a more aggressive treatment strategy.

Identification of an N6-methyladenosine-mediated positive feedback loop that promotes Epstein–Barr virus infection

“…Epstein–Barr virus (EBV), a large double-stranded DNA virus belonging to the γ-herpesvirus subfamily, causes latent infection of more than 95% of the adult population worldwide ( 1 , 2 ). As a widespread virus causing infectious mononucleosis during primary infection, EBV is also closely implicated in several malignancies in latent infection, including B-cell lymphomas, nasopharyngeal carcinoma (NPC) ( 3 , 4 , 5 ), EBV-associated gastric cancer, Burkitt's lymphoma, and Hodgkin's lymphoma ( 6 , 7 , 8 , 9 ). The viral oncogenic factors, such as RNA transcripts and proteins expressing during the latent or lytic phase have been reported to drive pathogenic processes ( 10 , 11 ).…”

A Nomogram for Predicting Distant Metastasis Using Nodal-Related Features Among Patients With Nasopharyngeal Carcinoma

“…The established nomogram demonstrated a high C-index in both the training and external validation cohorts, demonstrating its promising clinical significance. Pretreatment EBV DNA level had been demonstrated as an important biomarker for clinical management of NPC patients (18). Peng et al found that EBV DNA had an important prognostic value in predicting NPC patients' long-term survival after IMRT (19).…”

Prospective observation: Clinical utility of plasma Epstein–Barr virus DNA load in EBV‐associated gastric carcinoma patients

“…Plasma EBV-DNA load has been well documented as an effective marker for distinguishing disease-associated EBV reactivation from the presence of EBV in benign B lymphocytes, as well as for diagnostic screening and monitoring of EBV-associated diseases such as lymphoma and nasopharyngeal carcinoma (NPC). [15][16][17][18][19][20] Especially in NPC patients, the quantification of plasma EBV-DNA can be used to screen for early asymptomatic NPC, 21,22 monitoring recurrence and predicting prognosis. 18 Little has been done to evaluate the role of plasma EBV-DNA load in the diagnosis and monitoring of GC.…”