BACKGROUND: Epstein-Barr virus (EBV) DNA can be detected and quantified in the plasma of patients with EBV-related tumors, such as nasopharyngeal carcinoma (NPC). Although NPC at early stages can be cured by radical radiotherapy, there is a high recurrence rate in patients with advanced NPC. The pretreatment level of circulating EBV DNA is a prognostic factor for NPC, but the prognostic value of post-treatment EBV DNA has not been studied. We designed a prospective study in Hong Kong, China, to investigate the value of plasma EBV DNA as a prognostic factor for NPC. METHODS: One hundred seventy NPC patients, without metastatic disease at presentation, were treated with a uniform radiotherapy protocol. Circulating EBV DNA was measured by real-time quantitative polymerase chain reaction before treatment and 6-8 weeks after radiotherapy was completed. Risk ratios (RRs) were determined with a Cox regression model, and associations of various factors with progression-free and overall survival and recurrence rates were determined with a stepwise Cox proportional hazards model. All statistical tests were two-sided. RESULTS: Ninety-nine percent of patients achieved complete clinical remission. Levels of post-treatment EBV DNA dominated the effect of levels of pretreatment EBV DNA for progression-free survival. The RR for NPC recurrence was 11.9 (95% confidence interval [CI] = 5.53 to 25.43) for patients with higher post-treatment EBV DNA and 2.5 (95% CI = 1.14 to 5.70) for patients with higher pretreatment EBV DNA. Higher levels of post-treatment EBV DNA were statistically significantly associated with overall survival (P<.001; RR for NPC recurrence = 8.6, 95% CI = 3.69 to 19.97). The positive and negative predictive values for NPC recurrence for a higher level of post-treatment EBV DNA were 87% (95% CI = 58% to 98%) and 83% (95% CI = 76% to 89%), respectively. CONCLUSION: Levels of post-treatment plasma EBV DNA in patients with NPC appear to strongly predict progression-free and overall survival and to accurately reflect the post-treatment residual tumor load.
BACKGROUND: Epstein-Barr virus (EBV) DNA can be detected and quantified in the plasma of patients with EBV-related tumors, such as nasopharyngeal carcinoma (NPC). Although NPC at early stages can be cured by radical radiotherapy, there is a high recurrence rate in patients with advanced NPC. The pretreatment level of circulating EBV DNA is a prognostic factor for NPC, but the prognostic value of post-treatment EBV DNA has not been studied. We designed a prospective study in Hong Kong, China, to investigate the value of plasma EBV DNA as a prognostic factor for NPC. METHODS: One hundred seventy NPC patients, without metastatic disease at presentation, were treated with a uniform radiotherapy protocol. Circulating EBV DNA was measured by real-time quantitative polymerase chain reaction before treatment and 6-8 weeks after radiotherapy was completed. Risk ratios (RRs) were determined with a Cox regression model, and associations of various factors with progression-free and overall survival and recurrence rates were determined with a stepwise Cox proportional hazards model. All statistical tests were two-sided. RESULTS: Ninety-nine percent of patients achieved complete clinical remission. Levels of post-treatment EBV DNA dominated the effect of levels of pretreatment EBV DNA for progression-free survival. The RR for NPC recurrence was 11.9 (95% confidence interval [CI] = 5.53 to 25.43) for patients with higher post-treatment EBV DNA and 2.5 (95% CI = 1.14 to 5.70) for patients with higher pretreatment EBV DNA. Higher levels of post-treatment EBV DNA were statistically significantly associated with overall survival (P<.001; RR for NPC recurrence = 8.6, 95% CI = 3.69 to 19.97). The positive and negative predictive values for NPC recurrence for a higher level of post-treatment EBV DNA were 87% (95% CI = 58% to 98%) and 83% (95% CI = 76% to 89%), respectively. CONCLUSION: Levels of post-treatment plasma EBV DNA in patients with NPC appear to strongly predict progression-free and overall survival and to accurately reflect the post-treatment residual tumor load.
Authors: James S Lewis; David J Adelstein; Abbas Agaimy; Diane L Carlson; William C Faquin; Tim Helliwell; Jos Hille; Tony Ng; John M Nicholls; Brian O'Sullivan; Lester D R Thompson Journal: Arch Pathol Lab Med Date: 2018-11-30 Impact factor: 5.534
Authors: Sharon D Stoker; Maarten A Wildeman; Zlata Novalic; Renske Fles; Vincent van der Noort; Remco de Bree; Weibel W Braunius; Guido B van den Broek; Bas Kreike; Kenneth W Kross; Hedy Juwana; Octavia Ramayanti; Sandra A W M Verkuijlen; Jan Paul de Boer; Astrid E Greijer; Jaap M Middeldorp; I Bing Tan Journal: Eur Arch Otorhinolaryngol Date: 2015-05-01 Impact factor: 2.503
Authors: Quynh-Thu Le; Qiang Zhang; Hongbin Cao; Ann-Joy Cheng; Benjamin A Pinsky; Ruey-Long Hong; Joseph T Chang; Chun-Wei Wang; Kuo-Chien Tsao; Ym Dennis Lo; Nancy Lee; K Kian Ang; Anthony T C Chan; K C Allen Chan Journal: Clin Cancer Res Date: 2013-03-04 Impact factor: 12.531
Authors: Matthew E Spector; Janice L Farlow; Catherine T Haring; J Chad Brenner; Andrew C Birkeland Journal: Discov Med Date: 2018-05 Impact factor: 2.970
Authors: Zhixiong Lin; Brian Khong; Shirley Kwok; Hongbin Cao; Robert B West; Quynh-Thu Le; Christina S Kong Journal: Head Neck Date: 2013-10-26 Impact factor: 3.147