Plasma Epstein–Barr Viral Deoxyribonucleic Acid Predicts Worse Outcomes in Pediatric Nonmetastatic Nasopharyngeal Carcinoma Patients

Shen, Ting; Tang, Lin; Gu, Wei; Luo, Dong Hua; Chen, Qiu Yan; Li, Pei Jing; Dong, Mei; Qiang, Hai; Mo, Hao Yuan

doi:10.1097/md.0000000000001945

Cited by 12 publications

(11 citation statements)

References 22 publications

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“…Pretreatment pEBV-DNA is an important biomarker to predict survival and guide treatment for adults with NPC ( 20 , 21 ). We demonstrated a similar role of pEBV-DNA in survival prediction in CaNPC, which agreed with the result of a previous study ( 16 ). An observational study by Shen et al.…”

Section: Discussionsupporting

confidence: 92%

“…showed that the pretreatment pEBV-DNA load was an independent prognostic indicator for DMFS and OS in pediatric patients with NPC. In terms of overall survival, the cutoff value of pretreatment pEBV-DNA = 7,500 copies/ml was suggested for CaNPC in a retrospective analysis by Shen et al., which was also used in the present study ( 16 ). The difference in survival associated with pretreatment pEBV-DNA suggested that the treatment intensity of patients with different pretreatment pEBV-DNA levels could be individualized, which has been explored in adults with NPC ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

“…The patients’ pEBV-DNA concentrations were measured using quantitative real-time PCR (qPCR) before therapy ( 14 , 15 ). According to their pEBV-DNA level, the patients were divided into a high-risk group (≥7,500 copies/ml) and a low risk group (<7,500 copies/ml) based on a previous study in our institution, which demonstrated that pEBV-DNA at more than 7,500 copies/mL was an independent unfavorable prognostic factor for survival in CaNPC ( 16 ).…”

Section: Methodsmentioning

confidence: 99%

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Exploring the Optimal Chemotherapy Strategy for Locoregionally Advanced Children and Adolescent Nasopharyngeal Carcinoma Based on Pretreatment Epstein-Barr Virus DNA Level in the Era of Intensity Modulated Radiotherapy

et al. 2021

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BackgroundThe present study aimed to explore the optimal chemotherapy strategy for locoregionally advanced children and adolescent nasopharyngeal carcinoma (LcaNPC), based on the level of pretreatment plasma Epstein-Barr virus DNA (pEBV-DNA) in the era of intensity modulated radiation therapy (IMRT).MethodsThis real-world, retrospective study consecutively reviewed locoregionally advanced nasopharyngeal carcinoma patients younger than 22 years old from 2006 to 2016 in the Sun Yat-sen University Cancer Center. The Kaplan–Meier method with the log-rank test and the Cox regression model were used to investigate the survival outcomes of different chemotherapy intensities and pEBV-DNA. Treatment-related toxicity was also evaluated using the chi-squared test or Fisher’s exact test.ResultsA total of 179 patients were enrolled, including 86 patients in the high-risk group (pEBV-DNA ≥7,500 copies/ml) and 93 patients in the low-risk group (pEBV-DNA <7,500 copies/ml). Among all patients, those receiving low intensity induction chemotherapy (IC courses = 2) had a better 5-year overall survival (OS) than those receiving no IC (P = 0.025) and high intensity IC (IC courses >2) (P = 0.044). In the high-risk group, receipt of low intensity IC showed significant 5-year OS (P = 0.032), progression-free survival (PFS) (P = 0.027), and 5-year distant metastasis-free survival (DMFS) (P = 0.008) benefits compared with not receiving IC. Multivariate analyses identified that not receiving IC was a risk factor compared with low intensity IC for OS (hazard ratio (HR) = 10.933, P = 0.038) among all patients. Moreover, in the high-risk group, not receiving IC was a risk factor for 5-year OS (HR = 10.878, P = 0.038), 5-year PFS (HR = 5.705, P = 0.041), and 5-year DMFS (HR = 10.290, P = 0.040) compared to low intensity IC. There were no differences in survival for patients treated with or without concurrent chemotherapy.ConclusionTwo courses of platinum-based IC might be the optimal induction chemotherapy intensity to reduce risk of death, progression, and distant metastasis in patients with high pEBV-DNA levels.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Exploring the Optimal Chemotherapy Strategy for Locoregionally Advanced Children and Adolescent Nasopharyngeal Carcinoma Based on Pretreatment Epstein-Barr Virus DNA Level in the Era of Intensity Modulated Radiotherapy

et al. 2021

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“…This is in line with the results of Lin et al, who observed similar values of EBV DNA VL for stages III and IV . On the contrary, different results to our and Lin et al were presented by Shen et al's study, in which the median pretreatment concentrations of EBV DNA were significantly higher in patients with stage IV than in those with stage III …”

Section: Discussionsupporting

confidence: 91%

Prognostic significance of Epstein‐Barr virus viral load in patients with T1‐T2 nasopharyngeal cancer

Mazurek

Wygoda

Rutkowski

et al. 2019

Journal of Medical Virology

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Nasopharyngeal cancer (NPC) is highly prevalent in southern Chinese populations but it is rare in most parts of the world. A few studies were performed in nonendemic regions of the world, and suggested the prognostic value of Epstein-Barr virus (EBV) DNA load in blood. In this study, EBV DNA presence and viral load (VL) level in the blood of patients with NPC in Polish population were presented. In addition, its prognostic value for locoregional control among other clinicopathological features was evaluated. Patients with carcinoma of the nasopharynx treated definitively with radiotherapy or radiochemotherapy were included in the study. Real-time polymerase chain reaction was performed for quantitating of EBV DNA in plasma. Among patients with NPC, 51% (22 of 43) were classified as EBV-positive with the mean of the VL of 4934 ± 8693 copies/mL. Multiple regression analysis between log EBV DNA VL and clinical parameters revealed that the most important factors increasing the VLs were advanced N disease together with no-smoking status and advanced T tumors. Multivariate Cox regression analysis revealed that T3-T4 tumors were an independent prognostic factor for poor locoregional control. Analysis for the subgroup of patients with T1-T2 tumors showed that T1-T2 EBV-negative patients had better locoregional control compared with T1-T2 EBV-positive, though without statistical significance. In conclusion, it seems that EBV DNA determination may have an important role in diagnostics of patients with NPC with T1-T2 tumors indicating a subgroup with poorer prognosis, though it needs to be proven on a larger cohort. K E Y W O R D SEpstein-Barr virus, locoregional control, nasopharyngeal cancer, plasma, viral load

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“…To the best of our knowledge, studies that explore whether treatment outcomes can be predicted by pretreatment levels of plasma EBV DNA in young NPC patients are rare. Although one retrospective study (15) has reported that plasma EBV DNA predicts worse outcomes in pediatric nonmetastatic NPC patients, the findings were based on a relatively small sample size without using uniform IMRT technique.…”

Section: Introductionmentioning

confidence: 99%

Clinical Implications of Plasma Epstein–Barr Virus DNA in Children and Adolescent Nasopharyngeal Carcinoma Patients Receiving Intensity-Modulated Radiotherapy

Qiu

Guo

et al. 2020

Front. Oncol.

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Plasma Epstein–Barr Viral Deoxyribonucleic Acid Predicts Worse Outcomes in Pediatric Nonmetastatic Nasopharyngeal Carcinoma Patients

Abstract: Supplemental Digital Content is available in the text

Cited by 12 publications

References 22 publications

Exploring the Optimal Chemotherapy Strategy for Locoregionally Advanced Children and Adolescent Nasopharyngeal Carcinoma Based on Pretreatment Epstein-Barr Virus DNA Level in the Era of Intensity Modulated Radiotherapy

Exploring the Optimal Chemotherapy Strategy for Locoregionally Advanced Children and Adolescent Nasopharyngeal Carcinoma Based on Pretreatment Epstein-Barr Virus DNA Level in the Era of Intensity Modulated Radiotherapy

Prognostic significance of Epstein‐Barr virus viral load in patients with T1‐T2 nasopharyngeal cancer

Clinical Implications of Plasma Epstein–Barr Virus DNA in Children and Adolescent Nasopharyngeal Carcinoma Patients Receiving Intensity-Modulated Radiotherapy

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