Combination of Tumor Volume and Epstein-Barr Virus DNA Improved Prognostic Stratification of Stage II Nasopharyngeal Carcinoma in the Intensity Modulated Radiotherapy Era: A Large-Scale Cohort Study.

Qiu Yan Chen; Shao Yan Guo; Lin Quan Tang; Tong Yu LU; Bo Lin Chen; Qi Yu Zhong; Meng Sha Zou; Qing Nan Tang; Wen Hui Chen; Shan Shan Guo; Li Ting Liu; LI Yang; Ling Guo; Hao Yuan MO; Rui Sun; Dong Hua Luo; Chong Zhao; Ka Jia Cao; Chao Nan Qian; Xiang Guo; Mu Sheng Zeng; Hai Qiang Mai

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Combination of Tumor Volume and Epstein-Barr Virus DNA Improved Prognostic Stratification of Stage II Nasopharyngeal Carcinoma in the Intensity Modulated Radiotherapy Era: A Large-Scale Cohort Study.

Author: Qiu Yan CHEN ¹ ; Shao Yan GUO ; Lin Quan TANG ; Tong Yu LU ; Bo Lin CHEN ; Qi Yu ZHONG ; Meng Sha ZOU ; Qing Nan TANG ; Wen Hui CHEN ; Shan Shan GUO ; Li Ting LIU ; Yang LI ; Ling GUO ; Hao Yuan MO ; Rui SUN ; Dong Hua LUO ; Chong ZHAO ; Ka Jia CAO ; Chao Nan QIAN ; Xiang GUO ; Mu Sheng ZENG ; Hai Qiang MAI
Author Information

1. Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China. maihq@sysucc.org.cn
Publication Type:Original Article
Keywords: Nasopharyngeal carcinoma; Tumor burden; Epstein-Barr virus; Intensity modulated radiotherapy; Prognosis
MeSH: Biomarkers; Cohort Studies*; DNA*; Herpesvirus 4, Human*; Humans; Lymph Nodes; Nasopharynx; Plasma; Prognosis; Radiotherapy*; Tumor Burden*
From:Cancer Research and Treatment 2018;50(3):861-871
CountryRepublic of Korea
Language:English
Abstract: PURPOSE: Little is known about combination of the circulating Epstein-Barr viral (EBV) DNA and tumor volume in prognosis of stage II nasopharyngeal carcinoma (NPC) patients in the intensity modulated radiotherapy (IMRT) era. We conducted this cohort study to evaluate the prognostic values of combining these two factors. MATERIALS AND METHODS: By Kaplan-Meier, we compare the differences of survival curves between 385 patients with different EBV DNA or tumor volume levels, or with the combination of two biomarkers mentioned above. RESULTS: Gross tumor volume of cervical lymph nodes (GTVnd, p < 0.001) and total tumor volume (GTVtotal, p < 0.001) were both closely related to pretreatment EBV DNA, while gross tumor volume of nasopharynx (GTVnx, p=0.047) was weakly related to EBV DNA. EBV DNA was significantly correlated with progress-free survival (PFS, p=0.005), locoregional-free survival (LRFS, p=0.039), and distant metastasis-free survival (DMFS, p=0.017), while GTVtotal, regardless of GTVnx and GTVnd, had a significant correlation with PFS and LRFS. The p-values of GTVtotal for PFS and LRFS were 0.008 and 0.001, respectively. According to GTVtotal and pretreatment EBV DNA level, patients were divided into a low-risk group (EBV DNA 0 copy/mL, GTVtotal < 30 cm³; EBV DNA 0 copy/mL, GTVtotal ≥ 30 cm³; or EBV DNA > 0 copy/mL, GTVtotal < 30 cm³) and a high-risk group (EBV DNA > 0 copy/mL, GTVtotal ≥ 30 cm³). When patients in the low-risk group were compared with those in the high-risk group, 3-year PFS (p=0.003), LRFS (p=0.010), and DMFS (p=0.031) rates were statistically significant. CONCLUSION: Pretreatment plasma EBV DNA and tumor volume were both closely correlated with prognosis of stage II NPC patients in the IMRT era. Combination of EBV DNA and tumor volume can refine prognosis and indicate for clinical therapy.