Prognostic value of serum Epstein–Barr virus antibodies in patients with nasopharyngeal carcinoma and undetectable pretreatment Epstein–Barr virus DNA

Abstract

Epstein–Barr virus (EBV) is closely associated with nasopharyngeal carcinoma (NPC). Serum IgA antibodies against early antigen (EA‐IgA) and viral capsid antigen (VCA‐IgA) are the most commonly used to screen for NPC in endemic areas. However, the prognostic value of serum EA‐IgA and VCA‐IgA in patients with NPC is less clear. We hypothesize that serum EA‐IgA and VCA‐IgA levels have prognostic impact for survival outcomes in NPC patients with undetectable pretreatment EBV (pEBV) DNA. In this series, 334 patients with non‐metastatic NPC and undetectable pEBV DNA were included. Serum EA‐IgA and VCA‐IgA were determined by ELISA. After analysis, serum EA‐IgA and VCA‐IgA loads correlated positively with T, N, and overall stage (all P < 0.05). Serum EA‐IgA was not associated with survival outcome in univariable analyses. But patients with serum VCA‐IgA >1:120 had significantly inferior 5‐year progression‐free survival (80.4% vs 89.6%, P = 0.025), distant metastasis‐free survival (88.4% vs 94.8%, P = 0.050), and locoregional relapse‐free survival (88.4% vs 95.6%, P = 0.023; log–rank test). Multivariable analyses revealed that N stage was the only independent prognostic factor (all P < 0.05), but the VCA‐IgA became insignificant. Further analyses revealed that serum VCA‐IgA was not an independent prognostic factor in early N (N0–1) or advanced N (N2–3) stage NPC. In summary, although both EA‐IgA and VCA‐IgA correlate strongly with TNM stage, our analyses do not suggest that these antibodies are prognostic biomarkers in patients with NPC and undetectable pEBV DNA.

Prospective observation: Clinical utility of plasma Epstein–Barr virus DNA load in EBV‐associated gastric carcinoma patients

“…Dynamic monitoring of plasma EBV‐DNA can be used as a predictor for disease recurrence and treatment response in NPC patients . Detectable EBV‐DNA in plasma also provided a possibility for us to monitor treatment response in GC patients.…”

“…Dynamic monitoring of plasma EBV-DNA can be used as a predictor for disease recurrence and treatment response in NPC patients. 17,36,37 Detectable EBV-DNA in plasma also provided a possibility for us to monitor treatment response in GC patients. In our study, we prospectively monitored the change in plasma EBV-DNA in Stage IV EBVaGC patients and found that EBV-DNA decreased when the patients had PR or stable disease, while it increased when the disease progressed.…”

Histological subtype remains a prognostic factor for survival in nasopharyngeal carcinoma patients

“…Other prognostic factors include patient age and sex, molecular risk factors, lymph metastasis, and treatment regimens . Plasma EBV DNA has also been shown to be a predictive biomarker in patients with endemic NPC . However, as the results have been inconsistent, there is no consensus on the prognostic significance of the histological subtypes of NPC …”

“…10 Plasma EBV DNA has also been shown to be a predictive biomarker in patients with endemic NPC. 11,12 However, as the results have been inconsistent, there is no consensus on the prognostic significance of the histological subtypes of NPC. 13 This study aimed to examine the impact of histological subtype on survival in a large cohort of NPC patients based on the Surveillance, Epidemiology, and End Results (SEER) Program, a well-constructed database from multiple institutions in the United States.…”

Preliminary evaluation of a candidate international reference for Epstein–Barr virus capsid antigen immunoglobulin A in China

“…[13]However, Yao et al did not confirm the role of VCA-IgA as a prognostic biomarker among patients with NPC and undetectable EBV DNA. [24] A possible explanation for these contradictory results may be that the previous study obtained the positive results by IFA, although Yao et al uses ELISA (Beier kit). In the absence of calibrators, inter-assay differences among ELISA kits may affect the outcome, as explained in the limitations of this article [24] and was confirmed in our study (Total CV =43.11%), confirming once more the importance of the reference in VCA-IgA ELISA detection.…”