Combined pre-treatment and middle-treatment Epstein–Barr virus DNA load contributes to prognostication and treatment modification in nasopharyngeal carcinoma patients

作者：Kaiqi Lan, Jing-Rong Mao, Xuesong Sun, Su‐Chen Li, Siyi Xie, Rui Sun, Sai‐Lan Liu, Hai‐Qiang Mai · 发表于：Therapeutic Advances in Medical Oncology · 年份：2024 · DOI：10.1177/17588359231221343 · 被引用次数：14 · 研究领域：Viral-associated cancers and disorders、Head and Neck Cancer Studies、Polyomavirus and related diseases

Objective: To investigate whether pre-treatment and middle-treatment plasma Epstein–Barr virus (EBV) DNA loads are useful predictors of prognosis and indicators of therapy modification in nasopharyngeal carcinoma (NPC) patients undergoing radical concurrent chemoradiotherapy (CCRT). Methods: Plasma EBV DNA load was measured by quantitative polymerase chain reaction before treatment (pre-DNA) and during the second cycle of DDP (mid-DNA). The primary endpoint was 5-year progression-free survival (PFS). Results: A total of 775 NPC patients treated with CCRT were included. In total, 553 patients with pre-DNA <4000 copies/mL and 222 with ⩾4000 copies/mL. A total of 559 patients had mid-DNA undetectable and 216 had detectable. Multivariate analysis showed that pre- and mid-DNA were independent prognostic predictors of PFS [hazard ratio (HR), 2.035; 95% confidence interval (CI), 1.406–2.944; p < 0.001; HR, 1.597; 95% CI, 1.101–2.316; p = 0.014]. The area under the curve of the combination of pre-DNA and mid-DNA for 5-year PFS was higher than that of pre-DNA, mid-DNA, and tumor node metastasis (TNM) stage (0.679 versus 0.622, 0.608, 0.601). In the low-risk group (pre-DNA <4000 copies/mL and undetectable mid-DNA), patients receiving ⩽200 mg/m 2 showed similar efficacy as those receiving >200 mg/m 2 cumulative cisplatin dose (CCD) but were associated with fewer all-grade late toxicities. However, in the high-risk group (pre-DNA ⩾4000 copies/mL or detectable mid-DNA), patien...