Pretreatment Plasma EBV-DNA Load Guides Induction Chemotherapy Followed by Concurrent Chemoradiotherapy in Locoregionally Advanced Nasopharyngeal Cancer: A Meta-Analysis

作者：Lin Lai, Xinyu Chen, Chuxiao Zhang, Xishan Chen, Li Chen, Ge Tian, Xiaodong Zhu · 发表于：Frontiers in Oncology · 年份：2021 · DOI：10.3389/fonc.2020.610787 · 被引用次数：14 · 研究领域：Head and Neck Cancer Studies、Viral-associated cancers and disorders、Head and Neck Surgical Oncology

Background The efficacy of induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) in locoregionally advanced nasopharyngeal cancer (LA-NPC) is controversial. In this paper, we conduct a meta-analysis based on relevant studies to provide strong evidence for clinical strategies. Materials and Methods We searched the MEDLINE, Embase, Cochrane, PubMed, and Web of Science databases for studies that stratified patients based on a high or low plasma Epstein–Barr virus deoxyribonucleic acid (EBV-DNA) load before treatment and compared the clinical efficacy of IC+CCRT vs. CCRT alone in LA-NPC. We tested for heterogeneity of studies and conducted sensitivity analysis. Subgroup analysis was performed for overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRFS). Results Seven studies with a total of 5289 cases were finally included in the meta-analysis. The heterogeneity test revealed the homogeneity of OS ( I 2 = 0.0%, p =0.794), PFS ( I 2 = 0.0%, p =0.778), DMFS ( I 2 = 0.0%, p =0.997), and LRFS ( I 2 = 0.0%, p =0.697) in patients with EBV-DNA loads of ≥4000 copies/ml in both the IC+CCRT and CCRT groups. The results reveal that IC+CCRT significantly extended the OS (HR 0.70 [95% CI 0.58-0.83], p =0.000), PFS (HR 0.83 [95% CI 0.70-0.99], p =0.033), and DMFS (HR 0.79 [95% CI 0.69-0.9], p =0.000) of patients compared with the CCRT group, but there were no beneficial effects on LRFS (...