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Circulating EBV DNA, Globulin and Nodal Size Predict Distant Metastasis after Intensity-Modulated Radiotherapy in Stage II Nasopharyngeal Carcinoma.

Du XJ, Tang LL, Mao YP, Guo R, Sun Y, Lin AH, Ma J - J Cancer (2016)

Bottom Line: Multivariate analysis demonstrated a plasma Epstein-Barr virus (EBV) DNA level ≥ 4000 copies/mL, maximal axial diameter (MAD) of the cervical lymph nodes ≥ 30 mm and serum globulin level < 29.5 g/L were independent predictors of poor DMFS (P = 0.018; P = 0.019; P = 0.006, respectively).On the basis of these parameters, a prognostic model was developed as follows: 1) patients with no risk factors; 2) one risk factor; and 3) two or three risk factors.The 3-year distant metastasis-free survival rates for groups 1, 2 and 3 were 100%, 94.6% and 84.3%, respectively (P = 0.001).

View Article: PubMed Central - PubMed

Affiliation: 1. Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Guangzhou 510060, China;

ABSTRACT

Background: The optimal treatment for early-stage nasopharyngeal carcinoma (NPC) remains controversial. Identification of prognostic factors for metastasis and tumor progression is urgently required to improve clinical decision-making for patients with American Joint Committee on Cancer (AJCC) 2009 stage II NPC from the endemic area.

Methods: Consecutive newly-diagnosed patients (n=296) with non-disseminated, biopsy-proven stage II NPC were retrospectively reviewed; all patients received intensity-modulated radiotherapy and MRI follow-up. Plasma EBV DNA level, serum lactate dehydrogenase, serum albumin, serum globulin and leukocyte counts were measured before therapy. Survival rates were analyzed using the Kaplan-Meier method and log-rank test and multivariate Cox proportional hazards model.

Results: Median follow-up was 50.2 months (range, 8-69.5 months). Multivariate analysis demonstrated a plasma Epstein-Barr virus (EBV) DNA level ≥ 4000 copies/mL, maximal axial diameter (MAD) of the cervical lymph nodes ≥ 30 mm and serum globulin level < 29.5 g/L were independent predictors of poor DMFS (P = 0.018; P = 0.019; P = 0.006, respectively). On the basis of these parameters, a prognostic model was developed as follows: 1) patients with no risk factors; 2) one risk factor; and 3) two or three risk factors. The 3-year distant metastasis-free survival rates for groups 1, 2 and 3 were 100%, 94.6% and 84.3%, respectively (P = 0.001).

Conclusion: The prognostic model based on EBV DNA, serum globulin and nodal size may facilitate individualized treatment of patients with stage II NPC at high risk of distant metastasis.

No MeSH data available.


Related in: MedlinePlus

Factors related outcome regarding DMFS. Kaplan-Meier distant metastasis-free survival (DMFS) curves for patients with stage II NPC stratified by plasma EBV DNA level (A), serum globulin concentration (B), maximal axial diameter (MAD) of the cervical lymph nodes (C), and extracapsular spread of cervical lymph nodes (D).
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Figure 1: Factors related outcome regarding DMFS. Kaplan-Meier distant metastasis-free survival (DMFS) curves for patients with stage II NPC stratified by plasma EBV DNA level (A), serum globulin concentration (B), maximal axial diameter (MAD) of the cervical lymph nodes (C), and extracapsular spread of cervical lymph nodes (D).

Mentions: Univariate analysis identified a cervical lymph node MAD ≥ 30 mm (P = 0.030), extracapsular spread of cervical lymph nodes (P = 0.046), a plasma EBV DNA level ≥ 4,000 copies/mL (P = 0.012) and serum globulin level < 29.5 g/L (P = 0.025) as significant prognostic factors for poor DMFS. The cervical lymph node MAD (P = 0.014), chemotherapy (P = 0.032) and serum globulin level (P = 0.033) were also significantly associated with PFS (Table 1). The Kaplan-Meier curves for DMFS are shown in Figure 1.


Circulating EBV DNA, Globulin and Nodal Size Predict Distant Metastasis after Intensity-Modulated Radiotherapy in Stage II Nasopharyngeal Carcinoma.

Du XJ, Tang LL, Mao YP, Guo R, Sun Y, Lin AH, Ma J - J Cancer (2016)

Factors related outcome regarding DMFS. Kaplan-Meier distant metastasis-free survival (DMFS) curves for patients with stage II NPC stratified by plasma EBV DNA level (A), serum globulin concentration (B), maximal axial diameter (MAD) of the cervical lymph nodes (C), and extracapsular spread of cervical lymph nodes (D).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4829552&req=5

Figure 1: Factors related outcome regarding DMFS. Kaplan-Meier distant metastasis-free survival (DMFS) curves for patients with stage II NPC stratified by plasma EBV DNA level (A), serum globulin concentration (B), maximal axial diameter (MAD) of the cervical lymph nodes (C), and extracapsular spread of cervical lymph nodes (D).
Mentions: Univariate analysis identified a cervical lymph node MAD ≥ 30 mm (P = 0.030), extracapsular spread of cervical lymph nodes (P = 0.046), a plasma EBV DNA level ≥ 4,000 copies/mL (P = 0.012) and serum globulin level < 29.5 g/L (P = 0.025) as significant prognostic factors for poor DMFS. The cervical lymph node MAD (P = 0.014), chemotherapy (P = 0.032) and serum globulin level (P = 0.033) were also significantly associated with PFS (Table 1). The Kaplan-Meier curves for DMFS are shown in Figure 1.

Bottom Line: Multivariate analysis demonstrated a plasma Epstein-Barr virus (EBV) DNA level ≥ 4000 copies/mL, maximal axial diameter (MAD) of the cervical lymph nodes ≥ 30 mm and serum globulin level < 29.5 g/L were independent predictors of poor DMFS (P = 0.018; P = 0.019; P = 0.006, respectively).On the basis of these parameters, a prognostic model was developed as follows: 1) patients with no risk factors; 2) one risk factor; and 3) two or three risk factors.The 3-year distant metastasis-free survival rates for groups 1, 2 and 3 were 100%, 94.6% and 84.3%, respectively (P = 0.001).

View Article: PubMed Central - PubMed

Affiliation: 1. Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Guangzhou 510060, China;

ABSTRACT

Background: The optimal treatment for early-stage nasopharyngeal carcinoma (NPC) remains controversial. Identification of prognostic factors for metastasis and tumor progression is urgently required to improve clinical decision-making for patients with American Joint Committee on Cancer (AJCC) 2009 stage II NPC from the endemic area.

Methods: Consecutive newly-diagnosed patients (n=296) with non-disseminated, biopsy-proven stage II NPC were retrospectively reviewed; all patients received intensity-modulated radiotherapy and MRI follow-up. Plasma EBV DNA level, serum lactate dehydrogenase, serum albumin, serum globulin and leukocyte counts were measured before therapy. Survival rates were analyzed using the Kaplan-Meier method and log-rank test and multivariate Cox proportional hazards model.

Results: Median follow-up was 50.2 months (range, 8-69.5 months). Multivariate analysis demonstrated a plasma Epstein-Barr virus (EBV) DNA level ≥ 4000 copies/mL, maximal axial diameter (MAD) of the cervical lymph nodes ≥ 30 mm and serum globulin level < 29.5 g/L were independent predictors of poor DMFS (P = 0.018; P = 0.019; P = 0.006, respectively). On the basis of these parameters, a prognostic model was developed as follows: 1) patients with no risk factors; 2) one risk factor; and 3) two or three risk factors. The 3-year distant metastasis-free survival rates for groups 1, 2 and 3 were 100%, 94.6% and 84.3%, respectively (P = 0.001).

Conclusion: The prognostic model based on EBV DNA, serum globulin and nodal size may facilitate individualized treatment of patients with stage II NPC at high risk of distant metastasis.

No MeSH data available.


Related in: MedlinePlus