Abstract
PurposeEffective prognostic factors for patients with stage IVA/B nasopharyngeal carcinoma (NPC) who are susceptible to distant metastases are limited. We aim to investigate the prognostic value of pretreatment plasma fibrinogen (FIB) level and Epstein–Barr virus DNA (EBV-DNA) load in these patients in the era of intensity-modulated radiotherapy (IMRT).ResultsThe 5-year DSS, DFS and DMFS rates of the entire cohort were 72.7%, 66.8%, 80.0%, respectively. High FIB level was identified as a negative prognostic factor for survival: the 5-year DSS, DFS and DMFS rates for patients with high FIB (> 4.0 g/L) and normal FIB (≤ 4.0 g/L) were 60.3% vs. 76.0%, 56.0% vs. 69.9%, and 59.4% vs. 85.5%, respectively (all P < 0.001). Subgroup analysis demonstrated that DSS, DFS and DMFS decreased as FIB gradually increased, even within the normal range. The risk of distant metastasis in patients with high FIB was over 3-fold than patients with normal FIB. EBV-DNA was not an independent prognostic factor for any survival outcomes in multivariate analysis.ConclusionHigh pretreatment FIB level shows superior prognostic value than EBV-DNA load for stage IVA/B NPC patients in the era of IMRT.Materials and MethodsA total of 755 patients with newly-diagnosed stage IVA/B NPC treated with definitive IMRT between January 2007 and December 2011 were enrolled. Plasma FIB and EBV-DNA were measured before treatment. Disease-specific survival (DSS), disease-free survival (DFS) and distant metastasis-free survival (DMFS) were calculated using the Kaplan-Meier method; differences were compared using the log-rank test.
Highlights
Nasopharyngeal carcinoma (NPC), a malignant tumor type with a distinct geographical and ethnic pattern of incidence, is most common in southern China
We aim to investigate the prognostic value of pretreatment plasma fibrinogen (FIB) level and Epstein–Barr virus DNA (EBV-DNA) load in these patients in the era of intensity-modulated radiotherapy (IMRT)
High FIB level was identified as a negative prognostic factor for survival: the 5-year Disease-specific survival (DSS), disease-free survival (DFS) and distant metastasis-free survival (DMFS) rates for patients with high FIB (> 4.0 g/L) and normal FIB (≤ 4.0 g/L) were 60.3% vs. 76.0%, 56.0% vs. 69.9%, and 59.4% vs. 85.5%, respectively
Summary
Nasopharyngeal carcinoma (NPC), a malignant tumor type with a distinct geographical and ethnic pattern of incidence, is most common in southern China. The prognosis of stage IVA/B disease is much poorer than stage III disease and the 5-year overall survival rate is still around 60% to 70%, even though intensity-modulated radiotherapy (IMRT) has been widely used. [4,5,6] A relationship between cancer, hemostasis and inflammation has been widely accepted and over-expression of a number of procoagulant and fibrinolytic factors, especially fibrinogen (FIB), has been reported in malignant tumors. [7, 8] An elevated pretreatment plasma FIB level has been identified as a significant negative prognostic factor for poorer survival in various solid tumour types, including lung, breast, oesophageal cancers and NPC. The role of pretreatment FIB level in stage IVA/B NPC patients treated with IMRT remains unknown. Whether elevated EBVDNA remains to be an effective prognostic biomarker for stage IVA/B patients deserves further investigation
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