广东四会鼻咽癌患者治疗前EB病毒VCA/IgA抗体水平与生存的关系

Prognostic implication of pretreatment titer of serum immunoglobulin A against Epstein-Barr virus capsid antigen in nasopharyngeal carcinoma patients in Sihui city, Guangdong province

背景与目的:Epstein-Barr病毒VCA/IgA抗体(serum immunoglobulin A against Epstein-Barrvirus capsid antigen,EBV-VCA/IgA)是目前应用最广泛的鼻咽癌诊断指标之一,但它对鼻咽癌预后判断的意义尚不明确。本研究探讨VCA/IgA抗体水平与鼻咽癌患者长期生存的关系,为确立VCA/IgA能否作为鼻咽癌独立的预后指标提供依据。方法:根据广东省四会市肿瘤发病与死亡登记资料,选择1990至2003年在中山大学肿瘤防治中心治疗的全部317例四会籍初诊鼻咽癌患者,收集患者的临床与病理资料,分析患者治疗前血清VCA/IgA抗体不同水平与生存期的关系。结果:在临床分期中Ⅲ、Ⅳ期的抗体水平率较Ⅰ、Ⅱ期为高,P=0.01。抗体滴度越高的患者生存时间越短,低水平组(<1∶160)的患者(n=170)与高水平组(≥1∶160)患者(n=147)的5年生存率分别为65.0%和43.0%,P=0.01。多因素分析显示患者的临床分期、性别、治疗年代和EBV-VCA/IgA水平是影响生存期的独立因素。结论:鼻咽癌患者治疗前VCA/IgA抗体水平可能是影响患者生存的独立预后指标。

Background and Objective. Currently, the serum immunoglobulin A against Epstein-Barr virus capsid antigen （EBV-VCA/IgA） is one of the most commonly used markers for diagnosis of nasopharyngeal carcinoma （NPC）. However, its value for prognostic implication in NPC patients is unclear. This study was to evaluate the relationship between pretreatment titers of EBV-VCA/ IgA and NPC patients＇ survival. Methods. The clinicopathologic characteristics of 317 NPC patients treated in Sun Yat-sen University Cancer Center between 1990 and 2003 were collected. The follow-up data of these patients were retrieved from the registration system of cancer incidence and mortality of Sihui city, Guangdong province. The correlation of pretreatment EBV-VCA/IgA titers to the survival of these patients was analyzed. Results： Pretreatment VCA/IgA titer was significantly higher in stage Ⅲ-Ⅳ NPC patients than in stage Ⅰ - Ⅱ patients （P=0.01）. The survival time was significantly shorter in the 170 patients with higher EBV-VCA/IgA titers （≥ 1：160） than in the 147 patients with lower EBV-VCA/IgA titers （〈1：160）. The 5-year survival rate was 65% in low EBV-VCA/IgA titer group and 43% in high titer group （P=0.01）. Multivariate analyses showed that clinical stage, sex, the year of treatment, and pretreatment serum EBV-VCA/IgA titer were independent prognostic factors of NPC. Conclusion. Pretreatment serum EBV-VCA/IgA titer may be used as an independent prognostic marker of NPC.