The Prognostic Value of Plasma Epstein-Barr Viral DNA and Tumor Response to Neoadjuvant Chemotherapy in Advanced-Stage Nasopharyngeal Carcinoma.

Abstract

PURPOSE:

To explore the prognostic value of the plasma load of Epstein-Barr viral (EBV) DNA and the tumor response to neoadjuvant chemotherapy (NACT) in advanced-stage nasopharyngeal carcinoma (NPC).

PATIENTS AND METHODS:

In all, 185 consecutive patients with stage III to IVb NPC treated with NACT followed by concurrent chemoradiation therapy (CCRT) were prospectively enrolled. The primary endpoint was progression-free survival (PFS), and the secondary endpoints included locoregional relapse-free survival (LRFS) and distant metastasis-free survival (DMFS).

RESULTS:

EBV DNA was detected in 165 (89%) patients before treatment but was undetectable in 127 (69%) patients after NACT. Detectable EBV DNA levels after NACT were correlated with poor prognosis (3-year PFS 71.8% vs 85.2%, P=.008 and 3-year DMFS 82.5% vs 92.3%, P=.013). An unsatisfactory tumor response (stable disease or disease progression) after NACT was also correlated with poor clinical outcome (3-year PFS 71.1% vs 85.9%, P=.005 and 3-year LRFS 82.7% vs 93.5%, P=.012). Multivariate analysis showed that the EBV DNA level after NACT (hazard ratio [HR] 2.31, 95% CI 1.18-4.54, P=.015) and the tumor response to NACT (HR 2.84, 95% CI 1.42-5.67, P=.003) were both significant prognostic factors for PFS. Multivariate analysis also showed that EBV DNA after NACT was the only significant predictor of DMFS (HR 2.99, 95% CI 1.25-7.15, P=.014) and that tumor response to NACT was the only significant predictor of LRFS (HR 3.31, 95% CI 1.21-9.07, P=.020).

CONCLUSION:

Detectable EBV DNA levels and an unsatisfactory tumor response (stable disease or disease progression) after NACT serve as predictors of poor prognosis for patients with advanced-stage NPC. These findings will facilitate further risk stratification, early treatment modification, or both before CCRT.

• Authors: Li-Ting Liu, Lin-Quan Tang, Qiu-Yan Chen, Lu Zhang, Shan-Shan Guo, Ling Guo, Hao-Yuan Mo, Chong Zhao, Xiang Guo, Ka-Jia Cao, Chao-Nan Qian, Mu-Sheng Zeng, Jin-Xin Bei, Ming-Huang Hong, Jian-Yong Shao, Ying Sun, Jun Ma, Hai-Qiang Mai
• Journal: International journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 93 Issue 4 Pg. 862-9 (Nov 15 2015) ISSN: 1879-355X [Electronic] United States
• PMID: 26530755 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Chemical References

• DNA, Viral
• Cisplatin
• Fluorouracil

Topics

• Adult
• Aged
• Analysis of Variance
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Carcinoma
• Chemoradiotherapy
• Cisplatin (administration & dosage)
• DNA, Viral (blood)
• Disease Progression
• Disease-Free Survival
• Female
• Fluorouracil (administration & dosage)
• Herpesvirus 4, Human (genetics)
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Nasopharyngeal Carcinoma
• Nasopharyngeal Neoplasms (blood, drug therapy, radiotherapy, virology)
• Neoadjuvant Therapy
• Prognosis
• Time Factors
• Treatment Failure
• Treatment Outcome
• Young Adult