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Different prognostic values of plasma Epstein-Barr virus DNA and maximal standardized uptake value of 18F-FDG PET/CT for nasopharyngeal carcinoma patients with recurrence.

Shen T, Tang LQ, Luo DH, Chen QY, Li PJ, Mai DM, Guo SS, Liu LT, Qian CN, Guo X, Zeng MS, Mo HY, Mai HQ - PLoS ONE (2015)

Bottom Line: However, both elevated EBV DNA load (≥21,100 copies/ml) and distant SUVmax (≥13.55) were significantly associated with worse OS compared with the patients with EBV DNA <21,100 copies/ml or distant SUVmax <13.55 for the subgroup with distant recurrence (P=0.015 and P=0.006, respectively).The predictive ability of EBV DNA was superior to that of SUVmax (P=0.062).Both distant SUVmax and EBV DNA appear to be independent predictors of OS in patients with distant recurrence; however, the predictive ability of EBV DNA was superior to that of SUVmax.

View Article: PubMed Central - PubMed

Affiliation: The State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.

ABSTRACT

Purpose: To evaluate and compare the prognostic value of Epstein-Barr virus (EBV) DNA and maximal standard uptake values (SUVmax ) of 18F-fluoro-2-deoxy-D-glucose positron emission tomography (18F-FDG-PET) in subgroups of nasopharyngeal carcinoma (NPC) patients with locoregional or distant recurrence.

Patients and methods: A total of 194 patients with recurrent NPC (locoregional recurrence: 107, distant recurrence: 87) were enrolled. Patients took evidence of recurrence performed with 18F-FDG-PET and an EBV DNA test before salvage treatment. Clinical parameters, the status of EBV DNA and the value of SUVmax were used for survival analysis using the Kaplan-Meier method and the Cox proportional hazards regression model.

Results: In the subgroup of patients with locoregional recurrence, patients with SUVmax<8.65 had significantly better overall survival (OS) (P=0.005) compared with the patients with SUVmax ≥8.65. However, both elevated EBV DNA load (≥21,100 copies/ml) and distant SUVmax (≥13.55) were significantly associated with worse OS compared with the patients with EBV DNA <21,100 copies/ml or distant SUVmax <13.55 for the subgroup with distant recurrence (P=0.015 and P=0.006, respectively). The predictive ability of EBV DNA was superior to that of SUVmax (P=0.062). Multivariate analysis showed that SUVmax was only an independent prognostic factor for OS in patients with locoregional recurrence (P=0.042), whereas EBV DNA independently predicted OS for the patients with distant recurrence (P=0.007). For those patients with undetectable EBV DNA, SUVmax<8.65 was still an independent favorable prognostic factor (P=0.038).

Conclusions: SUVmax is a useful biomarker for predicting OS in nasopharyngeal carcinoma patients with locoregional recurrence or with undetectable EBV DNA. Both distant SUVmax and EBV DNA appear to be independent predictors of OS in patients with distant recurrence; however, the predictive ability of EBV DNA was superior to that of SUVmax.

No MeSH data available.


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Flowchart of patients enrolled in this study.
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pone.0122756.g001: Flowchart of patients enrolled in this study.

Mentions: A profile of this study is shown in Fig 1. Between July 2007 and December 2013, 208 patients were assessed and entered into this study. Fourteen cases were excluded: five due to diabetes or plasma glucose>200 mg/dl, two because there was not an initial failure after definitive radiotherapy, and the others due to attrition during follow-up or incomplete medical records. Therefore, 194 patients in all were eligible for analysis, among which 160 were men and 34 were women. Patient characteristics are described in Table 1. The primary histologic type of the 194 cases, 178 cases presented non-keratinizing undifferentiated carcinoma (formerly WHO type III), 4 cases presented non-keratinizing differentiated carcinoma (formerly WHO type II), only 1 presented keratinizing squamous cell carcinoma (type I) and 11 patients missed data. The mean age of all patients was 43.9 years (range, 10 to 70 years). Among the 194 patients, 107 had locoregional recurrence only, and 87 had distant failure with or without locoregional recurrence. 103 cases were diagnosed recurrence by pathology and 91 cases were diagnosed by imaging test. Based on whether the patients exhibited distant failure, all patients were divided into two subgroups, the locoregional recurrence group and the distant recurrence group. At the time of the final follow-up, 30 of 107 patients (28%) had died in the locoregional recurrence subgroup, whereas 31 of 87 patients (35.6%) had died in the distant recurrence subgroup. The median concentration of plasma EBV DNA was 4,000 copies/ml for patients with locoregional recurrence only, which was much lower than that of patients with distant metastasis (34,900 copies/ml, P<0.001). The median SUVmax for patients with distant recurrence was much higher than that of the locoregional recurrent patients (13.3 vs. 11.50, P<0.001). We found that EBV DNA could not be detected in 37 of 107 patients (34.6%) with locoregional recurrence only and 12 of 87 patients (13.8%) with distant recurrence. Spearman correlation analysis demonstrated that EBV DNA levels positively correlated with number of metastases and that SUVmax correlated with clinical restage and number of metastases (S1 Table).


Different prognostic values of plasma Epstein-Barr virus DNA and maximal standardized uptake value of 18F-FDG PET/CT for nasopharyngeal carcinoma patients with recurrence.

Shen T, Tang LQ, Luo DH, Chen QY, Li PJ, Mai DM, Guo SS, Liu LT, Qian CN, Guo X, Zeng MS, Mo HY, Mai HQ - PLoS ONE (2015)

Flowchart of patients enrolled in this study.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4390333&req=5

pone.0122756.g001: Flowchart of patients enrolled in this study.
Mentions: A profile of this study is shown in Fig 1. Between July 2007 and December 2013, 208 patients were assessed and entered into this study. Fourteen cases were excluded: five due to diabetes or plasma glucose>200 mg/dl, two because there was not an initial failure after definitive radiotherapy, and the others due to attrition during follow-up or incomplete medical records. Therefore, 194 patients in all were eligible for analysis, among which 160 were men and 34 were women. Patient characteristics are described in Table 1. The primary histologic type of the 194 cases, 178 cases presented non-keratinizing undifferentiated carcinoma (formerly WHO type III), 4 cases presented non-keratinizing differentiated carcinoma (formerly WHO type II), only 1 presented keratinizing squamous cell carcinoma (type I) and 11 patients missed data. The mean age of all patients was 43.9 years (range, 10 to 70 years). Among the 194 patients, 107 had locoregional recurrence only, and 87 had distant failure with or without locoregional recurrence. 103 cases were diagnosed recurrence by pathology and 91 cases were diagnosed by imaging test. Based on whether the patients exhibited distant failure, all patients were divided into two subgroups, the locoregional recurrence group and the distant recurrence group. At the time of the final follow-up, 30 of 107 patients (28%) had died in the locoregional recurrence subgroup, whereas 31 of 87 patients (35.6%) had died in the distant recurrence subgroup. The median concentration of plasma EBV DNA was 4,000 copies/ml for patients with locoregional recurrence only, which was much lower than that of patients with distant metastasis (34,900 copies/ml, P<0.001). The median SUVmax for patients with distant recurrence was much higher than that of the locoregional recurrent patients (13.3 vs. 11.50, P<0.001). We found that EBV DNA could not be detected in 37 of 107 patients (34.6%) with locoregional recurrence only and 12 of 87 patients (13.8%) with distant recurrence. Spearman correlation analysis demonstrated that EBV DNA levels positively correlated with number of metastases and that SUVmax correlated with clinical restage and number of metastases (S1 Table).

Bottom Line: However, both elevated EBV DNA load (≥21,100 copies/ml) and distant SUVmax (≥13.55) were significantly associated with worse OS compared with the patients with EBV DNA <21,100 copies/ml or distant SUVmax <13.55 for the subgroup with distant recurrence (P=0.015 and P=0.006, respectively).The predictive ability of EBV DNA was superior to that of SUVmax (P=0.062).Both distant SUVmax and EBV DNA appear to be independent predictors of OS in patients with distant recurrence; however, the predictive ability of EBV DNA was superior to that of SUVmax.

View Article: PubMed Central - PubMed

Affiliation: The State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.

ABSTRACT

Purpose: To evaluate and compare the prognostic value of Epstein-Barr virus (EBV) DNA and maximal standard uptake values (SUVmax ) of 18F-fluoro-2-deoxy-D-glucose positron emission tomography (18F-FDG-PET) in subgroups of nasopharyngeal carcinoma (NPC) patients with locoregional or distant recurrence.

Patients and methods: A total of 194 patients with recurrent NPC (locoregional recurrence: 107, distant recurrence: 87) were enrolled. Patients took evidence of recurrence performed with 18F-FDG-PET and an EBV DNA test before salvage treatment. Clinical parameters, the status of EBV DNA and the value of SUVmax were used for survival analysis using the Kaplan-Meier method and the Cox proportional hazards regression model.

Results: In the subgroup of patients with locoregional recurrence, patients with SUVmax<8.65 had significantly better overall survival (OS) (P=0.005) compared with the patients with SUVmax ≥8.65. However, both elevated EBV DNA load (≥21,100 copies/ml) and distant SUVmax (≥13.55) were significantly associated with worse OS compared with the patients with EBV DNA <21,100 copies/ml or distant SUVmax <13.55 for the subgroup with distant recurrence (P=0.015 and P=0.006, respectively). The predictive ability of EBV DNA was superior to that of SUVmax (P=0.062). Multivariate analysis showed that SUVmax was only an independent prognostic factor for OS in patients with locoregional recurrence (P=0.042), whereas EBV DNA independently predicted OS for the patients with distant recurrence (P=0.007). For those patients with undetectable EBV DNA, SUVmax<8.65 was still an independent favorable prognostic factor (P=0.038).

Conclusions: SUVmax is a useful biomarker for predicting OS in nasopharyngeal carcinoma patients with locoregional recurrence or with undetectable EBV DNA. Both distant SUVmax and EBV DNA appear to be independent predictors of OS in patients with distant recurrence; however, the predictive ability of EBV DNA was superior to that of SUVmax.

No MeSH data available.


Related in: MedlinePlus