Plasma Epstein-Barr viral DNA complements TNM classification of nasopharyngeal carcinoma in the era of intensity-modulated radiotherapy
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Lu Zhang1,2,*, Lin-Quan Tang1,2,*, Qiu-Yan Chen1,2, Huai Liu4,5,6, Shan-Shan Guo1,2, Li-Ting Liu1,2, Ling Guo1,2, Hao-Yuan Mo1,2, Chong Zhao1,2, Xiang Guo1,2, Ka-Jia Cao1,2, Chao-Nan Qian1,2, Mu-Sheng Zeng1, Jian-Yong Shao1,7, Ying Sun1,8, Jun Ma1,8, Ming-Huang Hong1,3, Hai-Qiang Mai1,2
1Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China
2Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China
3GCP Center, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China
4Department of Radiotherapy, Hunan Cancer Hospital, Changsha, P. R. China
5Department of Radiotherapy, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, P. R. China
6Key Laboratory of Translational Radiation Oncology, Changsha, P. R. China
7Department of Molecular Diagnostics, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China
8Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China
*These authors contributed equally to this work
Hai-Qiang Mai, e-mail: email@example.com
Ming-Huang Hong, e-mail: firstname.lastname@example.org
Keywords: nasopharyngeal carcinoma, Epstein-Barr viral DNA, TNM staging, intensity-modulated radiotherapy, prognosis
Received: July 31, 2015 Accepted: November 26, 2015 Published: December 24, 2015
Background: The objective of this study is to verify the prognostic value of pretreatment plasma Epstein-Barr viral deoxyribonucleic acid (pEBV DNA) levels in nasopharyngeal carcinoma (NPC) patients to complement TNM classification based on the application of the intensity-modulated radiotherapy (IMRT) technique.
Methods: In total, 1467 patients staged at I–IVa–b (M0) and treated with IMRT were retrospectively analyzed at our cancer center from January 2007 to December 2010. Patient survival among different stages and EBV DNA levels were compared.
Results: Outcome analyses of different stages and EBV DNA levels revealed that patients in stages II–III with low EBV DNA levels had similar survival as that of patients in stages IVa–b with low EBV DNA (5-yr overall survival (OS), 94.7% vs. 92.9% (P = 0.141), progression failure-free survival (PFS), 87.2% vs. 89.0% (P = 0.685), distant metastasis failure-free survival (DMFS), 93.5% vs. 92.4% (P = 0.394) and locoregional failure-free survival (LRFS), 93.8% vs. 96.3% (P = 0.523)). Conversely, patients in stages II–III with high EBV DNA had better survival than patients in stages IVa–b with high EBV DNA (5-yr OS, 82.7% vs. 71.7% (P = 0.001), PFS, 70.7% vs. 66.2% (P = 0.047), DMFS, 79.6% vs. 74.8% (P = 0.066) and LRFS, 89.3% vs. 87.6% (P = 0.425)) but poorer survival than patients in stages IVa–b with low EBV DNA (5-yr OS, 82.7% vs. 92.9% (P = 0.025), PFS, 70.7% vs. 89.0, (P < 0.001), DMFS, 79.6% vs. 92.4%, (P = 0.001), LRFS, 89.3% vs. 96.3%, (P = 0.022)).
Conclusion: pEBV DNA is a strong prognostic factor for patients with NPC when complemented with TNM staging in the era of IMRT application.
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