Integrating pre- and post-treatment Plasma Epstein-Barr Virus DNA levels for better prognostic prediction of Nasopharyngeal Carcinoma

Wanxia Li; Chao Yang; Zehong Lv; Junzheng Li; Zonghua Li; Xiaofei Yuan; Shuting Wu; Yue Yuan; Linchong Cui; Juan Lu; Jing Chen; Feipeng Zhao

doi:10.7150/jca.56397

Integrating pre- and post-treatment Plasma Epstein-Barr Virus DNA levels for better prognostic prediction of Nasopharyngeal Carcinoma

J Cancer. 2021 Mar 5;12(9):2715-2722. doi: 10.7150/jca.56397. eCollection 2021.

Authors

Wanxia Li^{1

2}, Chao Yang³, Zehong Lv¹, Junzheng Li⁴, Zonghua Li⁵, Xiaofei Yuan¹, Shuting Wu¹, Yue Yuan¹, Linchong Cui¹, Juan Lu¹, Jing Chen⁶, Feipeng Zhao⁷

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong, China.
² Department of Health Management, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong, China.
³ Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong, China.
⁴ Department of Otolaryngology-Head and Neck Surgery, Guangzhou Red Cross Hospital, Jinan University, Guangzhou 510220, Guangdong, China.
⁵ Department of Otolaryngology, 942 Hospital of the Chinese People's Liberation Army, Yinchuan750001, Ningxia, China.
⁶ School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, Guangdong, China.
⁷ Department of Otolaryngology-Head and Neck Surgery, the Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou 646000, Sichuan, China.

Abstract

Background: Pre- and post-treatment plasma Epstein-Barr virus (EBV) DNA are important biomarkers for the prognosis of nasopharyngeal carcinoma (NPC). This study was performed to determine the prognostic potential of integrating EBV DNA levels in plasma measured pre-treatment (pre-EBV) and 3 months post-treatment (3 m-EBV). Materials and methods: A total of 543 incident non-metastatic NPC patients treated with intensity-modulated radiotherapy, with or without chemotherapy, were reviewed. Patients were divided into four subgroups based on pre-EBV and 3 m-EBV status. The data for pre-EBV and 3 m-EBV samples were integrated, and the predictability of the survival of patients with NPC was analyzed. Results: There were significant differences in the 5-year progression-free survival, distant metastasis-free survival, locoregional relapse-free survival, and overall survival among the four patient subgroups (P<0.001). Patients who tested negative for both pre-EBV and 3 m-EBV had the best prognosis, followed by patients who tested positive for pre-EBV and negative for 3 m-EBV, and those who tested negative for pre-EBV and positive for 3 m-EBV; however, patients who tested positive for both pre-EBV and 3 m-EBV had the poorest chances of survival. Multivariate analyses demonstrated that integration of pre-EBV and 3 m-EBV data was an independent predictor of NPC progression in patients. Receiver operating characteristic curve analysis further confirmed that the combination of pre-EBV and 3 m-EBV had a greater prognostic value than pre-EBV or 3 m-EBV alone. Conclusions: Integrating pre-EBV and 3 m-EBV data could provide more accurate risk stratification and better prognostic prediction in NPC.

Keywords: EBV DNA; nasopharyngeal carcinoma; plasma; prognosis; risk stratification.