Clinical significance of Epstein-Barr Virus DNA load detected pre- and post-radiotherapy in nasopharyngeal carcinoma patients

Abstract

10558 Background: Plasma Epstein-Barr virus DNA (EBV DNA) load has been shown to be clinically useful in the detection, monitoring, and prognostication of nasopharyngeal carcinoma (NPC). However, the clinical significance of EBV DNA load detected at different time points has not been addressed to our knowledge. In this study, we investigated whether pre- and post-treatment plasma EBV DNA load have different prognostic implications in NPC patients who were treated with radiotherapy. Methods: Plasma samples from 69 patients with primary NPC were collected before and after radiation treatment, and subjected to a real-time quantitative polymerase-chain- reaction assay of EBV DNA load. The pre-treatment primary tumor volume (GTVnx) calculated through CT images and/or MRI were documented. All patients were scheduled to follow up. Results: The pre-treatment plasma EBV DNA concentration was significantly associated with primary tumor volume (Spearman correlation coefficient=0.614; P=0.000). With a cutoff value of 20,000 copies/ml and 0 copies/ml respectively for pre-treatment and post-treatment plasma EBV DNA copy number, patients with lower EBV DNA concentrations had statistically preferable progression-free survival,metastasis-free survival and overall survival compared with those with higher EBV DNA concentrations. Cox regression analysis demonstrated that both pre-treatment EBV DNA load (P=0.050;RR=3.95) and post-treatment EBV DNA load (P=0.001;RR=11.74) were risk factors for metastasis-free survival. When further integrating pre-treatment with post-treatment concentration of EBV DNA, it was demonstrated that whether EBV DNA concentration could be dropped to 0 after treatment dominate the prognostic effect for metastasis-free survival (P=0.000). Conclusions: Pre- and post-treatment plasma EBV DNA have different clinical significance. Pre-treatment plasma EBV DNA is a reliable molecular marker reflecting primary tumor volume. While the clearance of circulating plasma EBV DNA after treatment is a good predictive marker of freedom from distant metastasis. No significant financial relationships to disclose.