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Comparative Study
. 2019 Aug;8(10):4633-4643.
doi: 10.1002/cam4.2339. Epub 2019 Jul 3.

Clinical characteristics and prognostic value of pre-retreatment plasma epstein-barr virus DNA in locoregional recurrent nasopharyngeal carcinoma

Ming-Zhu Liu  1   2   3   4 , Shuo-Gui Fang  1   2   3   4 , Wei Huang  1   2   3   4 , Han-Yu Wang  1   2   3   4 , Yun-Ming Tian  5 , Run-Da Huang  1   2   3   4 , Zhuang Sun  1   2   3   4 , Chong Zhao  1   2   3   4 , Tai-Xiang Lu  1   2   3   4 , Ying Huang  1   2   3   4 , Fei Han  1   2   3   4
Affiliations
Comparative Study

Clinical characteristics and prognostic value of pre-retreatment plasma epstein-barr virus DNA in locoregional recurrent nasopharyngeal carcinoma

Ming-Zhu Liu et al. Cancer Med. 2019 Aug.

Abstract

Purpose: To define the clinical characteristics and prognostic value of pre-retreatment plasma Epstein-Barr virus (EBV) DNA, we investigated EBV status in locoregional recurrent nasopharyngeal carcinoma (lrNPC) patients.

Methods: Between April 2008 and August 2016, the data of patients with nonmetastatic lrNPC were retrospectively reviewed. The survival indexes of patients between different pre-retreatment EBV status groups were compared.

Results: A total of 401 patients with nonmetastatic lrNPC were enrolled, and 197 (49.1%) patients had detectable pre-retreatment plasma EBV DNA. Treatment included radiotherapy alone (n = 37 patients), surgery alone (n = 105), radiotherapy (n = 208), surgery combined with radiotherapy (n = 20), chemotherapy and targeted therapy (n = 31). Median follow-up was 32 months. The 3-year locoregional relapse-free survival (LRRFS), distant metastasis-free survival (DMFS), and overall survival (OS) rates for the entire cohort were 64.8%, 89.4%, and 58.8%, respectively. The estimated 3-year LRRFS, DMFS, and OS rates for the pre EBV-positive group vs the pre EBV-negative group were 54.2% vs 75.0% (P < 0.001), 86.6% vs 91.9% (P = 0.05), 51.6% vs 65.9% (P = 0.01), respectively. Among patients in the clinical stage rI/II, there were 17 patients in the radiotherapy alone group and 49 patients in the surgery alone group. And there was no significant difference in overall survival between radiotherapy and surgery, even among the different pre-EBV statuses (P > 0.05). In terms of long-term toxic and side effects, the incidence of radioactive temporal lobe injury in the radiotherapy group was higher than that in the surgery group (35.3% vs 8.2%, P < 0.001), and no statistically significant difference was found in other long-term toxic and side effects.

Conclusions: The positive rate of pre-retreatment plasma EBV DNA in lrNPC is lower than primary NPC. The prognosis of EBV DNA negative group is better than positive group. For locally early-stage lrNPC, regardless of EBV DNA status, radiotherapy and surgery are available options and both can achieve better long-term survival.

Keywords: Epstein-Barr Virus DNA; clinical characteristics; prognostic; recurrent nasopharynx.

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Figures

Figure 1
Figure 1
CONSORT flow diagram
Figure 2
Figure 2
Kaplan‐Meier LRRFS. (A) DMFS (B) and OS (C) curves for locoregional recurrent NPC patients classified into pre‐retreatment EBV‐negative and pre‐retreatment EBV‐positive groups. LRRFS, local‐regional relapse‐free survival; DMFS, distant metastasis‐free survival; OS, overall survival
Figure 3
Figure 3
Kaplan‐Meier LRRFS. (A) DMFS (B) and OS (C) curves for locoregional recurrent NPC patients with rI+rII stage and stratified by treatment with RT alone and S alone. LRRFS, local‐regional relapse‐free survival; DMFS, distant metastasis‐free survival; OS, overall survival; RT, radiotherapy; S, surgery
Figure 4
Figure 4
Kaplan‐Meier Effect of treatment regimen on survival outcomes in patients with rI+rII stage and stratified by different pre‐retreatment EBV statuses. Kaplan–Meier overall survival: (A) for patients with undetectable pre‐retreatment EBV and (B) for patients with detectable pre‐retreatment EBV stratified by RT alone or S alone. OS, overall survival; RT, radiotherapy; S, surgery
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