Oral oncology · 2026
Prognostic value of early Epstein-Barr Virus DNA response in patients with locoregionally advanced nasopharyngeal carcinoma.
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Du Chengrun, Zhai Ruiping, Kong Fangfang, Niu Xiaoshuang, Xue Fen, He Xiayun, Hu Chaosu, Ying Hongmei
Аннотация
BACKGROUND: To explore the prognostic value of early Epstein-Barr Virus DNA response in locoregionally advanced nasopharyngeal carcinoma (LA-NPC).
METHODS: Patients with stage III to IVA nonkeratinizing NPC were enrolled who received induction chemotherapy (IC) with gemcitabine and cisplatin, followed by definitive radiotherapy (RT) or concurrent chemoradiotherapy (CCRT). Plasma EBV DNA levels were assessed within one week prior to the initiation of the first IC cycle and within three days before subsequent cycles.
RESULTS: A total of 273 patients were enrolled from August 12, 2020, to September 21, 2023. The C-index for EBV DNA post-C1 level to predict disease progression were 0.68, 0.7, 0.68 at 1, 2, 3 years, and 0.47, 0.62, 0.5 for baseline EBV DNA level. Patients with EBV DNA post-C1 levels ≥450 copies/ml demonstrated a worse PFS compared to those with EBV DNA post-C1 levels <450 copies/ml (2-year PFS: 74.7% [95% CI, 64.9 to 84.5] vs. 92.6% [95% CI, 88.48 to 96.7], p < 0.001). Multivariable analyses identified only EBV DNA post-C1 and the overall TNM stage as independent prognostic factors for PFS. Among patients with EBV DNA post-C1 < 450 copies/ml, IC + RT yielded comparable outcome to IC + RTcombined in terms of two-year PFS (93.5% [95% CI, 88.01 to 98.98] vs. 91.8% [95% CI, 85.92 to 97.68], p = 0.616), with reduced treatment-related toxicity.
CONCLUSIONS: EBV DNA post-C1 serves as an early prognostic biomarker for patient risk stratification. The utilization of EBV DNA post-C1 for personalized treatment warrants further validation through additional studies.
METHODS: Patients with stage III to IVA nonkeratinizing NPC were enrolled who received induction chemotherapy (IC) with gemcitabine and cisplatin, followed by definitive radiotherapy (RT) or concurrent chemoradiotherapy (CCRT). Plasma EBV DNA levels were assessed within one week prior to the initiation of the first IC cycle and within three days before subsequent cycles.
RESULTS: A total of 273 patients were enrolled from August 12, 2020, to September 21, 2023. The C-index for EBV DNA post-C1 level to predict disease progression were 0.68, 0.7, 0.68 at 1, 2, 3 years, and 0.47, 0.62, 0.5 for baseline EBV DNA level. Patients with EBV DNA post-C1 levels ≥450 copies/ml demonstrated a worse PFS compared to those with EBV DNA post-C1 levels <450 copies/ml (2-year PFS: 74.7% [95% CI, 64.9 to 84.5] vs. 92.6% [95% CI, 88.48 to 96.7], p < 0.001). Multivariable analyses identified only EBV DNA post-C1 and the overall TNM stage as independent prognostic factors for PFS. Among patients with EBV DNA post-C1 < 450 copies/ml, IC + RT yielded comparable outcome to IC + RTcombined in terms of two-year PFS (93.5% [95% CI, 88.01 to 98.98] vs. 91.8% [95% CI, 85.92 to 97.68], p = 0.616), with reduced treatment-related toxicity.
CONCLUSIONS: EBV DNA post-C1 serves as an early prognostic biomarker for patient risk stratification. The utilization of EBV DNA post-C1 for personalized treatment warrants further validation through additional studies.