Prognostic model for distant metastasis in locally advanced nasopharyngeal carcinoma after concurrent chemoradiotherapy

Chen, Chuangzhen; Chen, Siqia; Le, Quynh‐Thu; Chen, Jianzhou; Chen, Zhijian; Li, Dongsheng; Zhou, Meifang; Li, Derui

doi:10.1002/hed.23583

Cited by 11 publications

(8 citation statements)

References 23 publications

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“…Recently, several studies were conducted to stratify NPC patients into different groups based on the risk of distant metastasis to improve prognosis prediction [ 26 – 30 ]. For example, the study reported by Chen et al [ 28 ] included age, N category, hemoglobin level, and lactate dehydrogenase level to the prognostic model, and found that the prognostic model was useful for predicting the risk of distant metastasis in patients with locally advanced NPC. Another study by Zhang et al [ 30 ] incorporated fluor-18-fluorodeoxyglucose ( 18 F-FDG) uptake value; N category was also confirmed to be a predictor for distant metastasis in their study.…”

Section: Discussionmentioning

confidence: 99%

Prognostic values of the integrated model incorporating the volume of metastatic regional cervical lymph node and pretreatment serum Epstein–Barr virus DNA copy number in predicting distant metastasis in patients with N1 nasopharyngeal carcinoma

et al. 2017

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BackgroundAccording to the 7th edition of the American Joint Committee on Cancer (AJCC) staging system, over 50% of patients with nasopharyngeal carcinoma (NPC) have N1 disease at initial diagnosis. However, patients with N1 NPC are relatively under-researched, and the metastasis risk of this group is not well-stratified. This study aimed to evaluate the prognostic values of gross tumor volume of metastatic regional lymph node (GTVnd) and pretreatment serum copy number of Epstein–Barr virus (EBV) DNA in predicting distant metastasis of patients with N1 NPC, and to develop an integrated prognostic model that incorporates GTVnd and EBV DNA copy number for this group of patients.MethodsThe medical records of 787 newly diagnosed patients with nonmetastatic, histologically proven N1 NPC who were treated at Sun Yat-sen University Cancer Center between November 2009 and February 2012 were analyzed. Computed tomography-derived GTVnd was measured using the summation-of-area technique. Blood samples were collected before treatment to quantify plasma EBV DNA. The receiver operating characteristic (ROC) curve analysis was used to evaluate the cut-off point for GTVnd, and the area under the ROC curve was used to assess the predicted validity of GTVnd. The survival rates were assessed by Kaplan–Meier analysis, and the survival curves were compared using a log-rank test. Multivariate analysis was conducted using the Cox proportional hazard regression model.ResultsThe 5-year distant metastasis-free survival (DMFS) rates for patients with GTVnd > 18.9 vs. ≤ 18.9 mL were 82.2% vs. 93.2% (P < 0.001), and for patients with EBV DNA copy number > 4000 vs. ≤ 4000 copies/mL were 83.5% vs. 93.9% (P < 0.001). After adjusting for GTVnd, EBV DNA copy number, and T category in the Cox regression model, both GTVnd > 18.9 mL and EBV DNA copy number > 4000 copies/mL were significantly associated with poor prognosis (both P < 0.05). According to combination of GTVnd and EBV DNA copy number, all patients were divided into low-, moderate-, and high-risk groups, with the 5-year DMFS rates of 96.1, 87.4, and 73.8%, respectively (P < 0.001). Multivariate analysis confirmed the prognostic value of this model for distant metastatic risk stratification (hazard ratio [HR], 4.17; 95% confidence interval [CI] 2.34–7.59; P < 0.001).ConclusionsGTVnd and serum EBV DNA copy number are independent prognostic factors for predicting distant metastasis in NPC patients with N1 disease. The prognostic model incorporating GTVnd and EBV DNA copy number may improve metastatic risk stratification for this group of patients.

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Section: Discussionmentioning

confidence: 99%

Prognostic values of the integrated model incorporating the volume of metastatic regional cervical lymph node and pretreatment serum Epstein–Barr virus DNA copy number in predicting distant metastasis in patients with N1 nasopharyngeal carcinoma

et al. 2017

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“…It has also been shown that preservation of salivary function and quality of life improves in IMRT survivors. A recent multicenter study also showed that in a multi-institutional setting, it was possible to achieve 90% local control rate excellence with IMRT as reported in single institutions [ 10 , 11 ]. Thus, IMRT has gradually been considered as the new standard RT for NPC.…”

Section: Discussionmentioning

confidence: 89%

Integrated Diagnostic Model That Incorporates Epstein-Barr Virus DNA, Imaging, and Nasal Endoscopy to Stratify Primary Tumor and Lymph Nodes in a Patient with N1 Nasopharyngeal Carcinoma: Multidisciplinary Management

Gamba

Rota²,

Abeni³

et al. 2018

Case Rep Oncol

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Nasopharyngeal carcinoma (NPC) is an epithelial malignancy, with a high metastatic potential. Epstein-Barr virus (EBV) infection plays a fundamental role, even if it is not well understood. The diagnosis of the disease in its early stage is infrequent. Imaging studies, positron emission tomography scans in addition to clinical examination, endoscopic examination, and biopsy provide information on the extent of the disease. The application of neoadjuvant chemotherapy followed by concomitant chemoradiation can improve the control of NPC. In March 2016, a 54-year-old male with NPC cT1 cN2 cM0, stage III (8th edition of American Joint Committee on Cancer (AJCC) staging system) underwent to a two-step treatment: induction chemotherapy by TPF regimen (docetaxel, cisplatin, 5-fluorouracil), followed by concomitant chemoradiotherapy (weekly cisplatin). The quantity of free plasma EBV-DNA can be related to the disease stage, and the detection of EBV-DNA during follow-up can be predictive of distant metastases. Especially, either plasma or serum EBV-DNA titer is estimated to reflect tumor volume. Biologically, such EBV-DNA reflects reproduced or released DNA from dead or dying tumor cells. On the other hand, EBV-specific DNA released as exosome may reflect the biological feature of the alive NPC tumor cell. The follow-up is ongoing after 21 months from a complete response.

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“…These include DNA fragments containing hypermethylated promoter regions for several known tumour suppressor genes (e.g. CDH1, DAPK, and CDKN2A) 149,150 , hemoglobin and lactate dehydrogenase 151 , as well as multiple circulating cytokines including TGF-β 152 , interferon-γ 153 , and CD40-ligand 154 .…”

Section: Ebna1mentioning

confidence: 99%

The Role of MicroRNAs in Human Nasopharyngeal Carcinoma

Bruce

Hui

Waggot

et al. 2012

International Journal of Radiation Oncology*Biology*Physics

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Despite significant improvement in locoregional control in the contemporary era, nasopharyngeal carcinoma (NPC) patients still suffer from a significant risk of distant metastasis (DM). Thus, developing methods to better identify and treat NPC patients at risk of DM is of paramount importance. MicroRNAs (miRNAs) have been shown to provide insight into both the biology and clinical behaviour of human cancers; hence, this thesis aims to characterize both the First, I would like to express my deep gratitude to my supervisor and mentor, Fei-Fei Liu for her continuous scientific, personal and professional guidance. Her enthusiasm for scientific discovery and constant focus on using these discoveries to impact patient care are what gave me purpose and kept me engaged during the long hours of bench work and data analysis. Her extensive network of fellow researchers and physicians, and confidence in my abilities (even when I sometimes lacked the same confidence in myself) also provided me with the opportunity to participate in many exciting collaborations. In addition, I would like to thank the other members of my advisory committee, Lori Frappier and Laurie Ailles for their time and effort. Their thoughtful review of the progress of my project and valuable scientific advice was instrumental to my success as a PhD candidate. I would also like to acknowledge the members of the Liu Lab; past and present. In particular, Angela Hui who was my mentor and colleague in much of the work presented in this thesis. Her extensive knowledge of nasopharyngeal carcinoma, biospecimen analysis, and cell biology was invaluable as I navigated the waters of translational research. A special thanks also to

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Prognostic model for distant metastasis in locally advanced nasopharyngeal carcinoma after concurrent chemoradiotherapy

Abstract: The established model might be useful for predicting the risk of distant metastasis in patients with locally advanced NPC who underwent CCRT and may identify the patients' need for intensified adjuvant chemotherapy.

Cited by 11 publications

References 23 publications

Prognostic values of the integrated model incorporating the volume of metastatic regional cervical lymph node and pretreatment serum Epstein–Barr virus DNA copy number in predicting distant metastasis in patients with N1 nasopharyngeal carcinoma

Prognostic values of the integrated model incorporating the volume of metastatic regional cervical lymph node and pretreatment serum Epstein–Barr virus DNA copy number in predicting distant metastasis in patients with N1 nasopharyngeal carcinoma

Integrated Diagnostic Model That Incorporates Epstein-Barr Virus DNA, Imaging, and Nasal Endoscopy to Stratify Primary Tumor and Lymph Nodes in a Patient with N1 Nasopharyngeal Carcinoma: Multidisciplinary Management

The Role of MicroRNAs in Human Nasopharyngeal Carcinoma

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