Abstract
BackgroundThis study was performed to investigate whether long‐term monitoring of dynamic changes in plasma Epstein‐Barr virus (EBV) DNA could improve prognosis prediction of nasopharyngeal carcinoma (NPC).Materials and methodsAbout 1077 nonmetastatic NPC patients were recruited to retrospectively analyze the prognostic value of plasma EBV DNA load pretreatment and 3, 12, 24, and 36 months posttreatment. We also examined the prognostic value of dynamic changes in plasma EBV DNA at various time points.ResultsPatients with plasma EBV DNA load above optimal pre‐ and posttreatment cut‐offs had significantly worse five‐year progression‐free survival, distant metastasis‐free survival, locoregional relapse‐free survival, and overall survival (OS) at all‐time points, excluding only OS at 36 months posttreatment due to limited mortalities. Patients with persistently undetectable plasma EBV DNA at the first four time points had the best prognosis, followed by those with positive detection pretreatment and consistently negative detection posttreatment, those with negative detection pretreatment and positive detection at one time point posttreatment, and those with positive detection pretreatment and at one time point posttreatment, whereas patients with positive detection at ≥2 time points posttreatment had the worst prognosis. Cox proportional hazard models identified the dynamic change pattern as an independent prognostic factor, and receiver operating characteristic curve analysis demonstrated that the dynamic change at four time point was more valuable than any single time point for predicting disease progression, distant metastasis, locoregional relapse, and mortality.ConclusionsDynamic changes in plasma EBV DNA pre‐ and posttreatment could predict the long‐term survival outcome and provide accurate risk stratification in NPC.
Highlights
This study was performed to investigate whether long-term monitoring of dynamic changes in plasma Epstein-Barr virus (EBV) DNA could improve prognosis prediction of nasopharyngeal carcinoma (NPC)
EBV DNA is widely considered as a reliable biomarker for early screening, clinical staging, prognosis prediction, individualized treatment and follow-up monitoring in NPC [7,8,9,10,11,12,13].While multiple studies have reported that plasma EBV DNA could be used as a predictive marker for NPC prognosis [5, 14,15,16,17,18], these studies only measured plasma EBV DNA load at limited time points, such as pre-treatment and 3 months post-treatment
We suggested that a long-term monitoring of dynamic changes of plasma EBV DNA could improve its prognostic value in NPC.In a meta-analysis by Qu et al [19], plasma EBV DNA was measured primarily from day 1 to 3 months post-treatment
Summary
This study was performed to investigate whether long-term monitoring of dynamic changes in plasma Epstein-Barr virus (EBV) DNA could improve prognosis prediction of nasopharyngeal carcinoma (NPC). Identification of biomarkers to predict locoregional relapse and distant metastasis would be of great clinical value for improved survival and better prognosis. We suggested that a long-term monitoring of dynamic changes of plasma EBV DNA could improve its prognostic value in NPC.In a meta-analysis by Qu et al [19], plasma EBV DNA was measured primarily from day 1 to 3 months post-treatment. The prognostic value of plasma EBV DNA at other time points, such as more than 3 months post-treatment, requires further study
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