Abstract
PurposeTo evaluate and compare the prognostic value of Epstein-Barr virus (EBV) DNA and maximal standard uptake values (SUVmax ) of 18F-fluoro-2-deoxy-D-glucose positron emission tomography (18F-FDG-PET) in subgroups of nasopharyngeal carcinoma (NPC) patients with locoregional or distant recurrence.Patients and MethodsA total of 194 patients with recurrent NPC (locoregional recurrence: 107, distant recurrence: 87) were enrolled. Patients took evidence of recurrence performed with 18F-FDG-PET and an EBV DNA test before salvage treatment. Clinical parameters, the status of EBV DNA and the value of SUVmax were used for survival analysis using the Kaplan-Meier method and the Cox proportional hazards regression model.ResultsIn the subgroup of patients with locoregional recurrence, patients with SUVmax<8.65 had significantly better overall survival (OS) (P=0.005) compared with the patients with SUVmax ≥8.65. However, both elevated EBV DNA load (≥21,100 copies/ml) and distant SUVmax (≥13.55) were significantly associated with worse OS compared with the patients with EBV DNA <21,100 copies/ml or distant SUVmax <13.55 for the subgroup with distant recurrence (P=0.015 and P=0.006, respectively). The predictive ability of EBV DNA was superior to that of SUVmax (P=0.062). Multivariate analysis showed that SUVmax was only an independent prognostic factor for OS in patients with locoregional recurrence (P=0.042), whereas EBV DNA independently predicted OS for the patients with distant recurrence (P=0.007). For those patients with undetectable EBV DNA, SUVmax<8.65 was still an independent favorable prognostic factor (P=0.038).ConclusionsSUVmax is a useful biomarker for predicting OS in nasopharyngeal carcinoma patients with locoregional recurrence or with undetectable EBV DNA. Both distant SUVmax and EBV DNA appear to be independent predictors of OS in patients with distant recurrence; however, the predictive ability of EBV DNA was superior to that of SUVmax.
Highlights
In the subgroup of patients with locoregional recurrence, patients with the maximal standardized uptake value (SUVmax)
SUVmax is a useful biomarker for predicting OS in nasopharyngeal carcinoma patients with locoregional recurrence or with undetectable EBV DNA
When patients clinically indicated with locoregional recurrence or distant recurrence, wholebody 18F-FDG PET examination and EBV DNA measurement were performed on each patient before salvage treatment
Summary
Nasopharyngeal carcinoma (NPC) is common in southern China, especially in the Guangdong province, where rates range from 20 to 30 cases per 100,000 population.[1, 2] Radiotherapy is the primary treatment modality for NPC, and concurrent chemo-radiotherapy (CCRT) with or without adjuvant chemotherapy is the standard treatment regimen for locoregional advanced disease.[3, 4] Despite significant improvements in local control due to advances in radiotherapy and combined modality treatments, local recurrence and distant metastasis remain the predominant mode of failure in patients with advanced NPC.[5, 6] Locoregional recurrent NPC re-irradiated by IMRT can still have an encouraging outcome; the 5-year local control rate (LCR) and overall survival rate (OS) for recurrent stage I, II, III and IV were 80.0%, 85.0%, 80.0% and 78.7% and 71.4%, 62.9%, 35.5% and 30.2%, respectively.[7]. The identification of effective prognostic factors that more accurately correlate with treatment outcome would be of great importance for determining which NPC patients might benefit from intense treatment.[9]
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