血浆EBV DNA监测鼻咽癌治疗疗效意义

The value of plasma EBV DNA in monitoring the therapeutic effect of nasopharyngeal carcinoma

目的探讨血浆EBV DNA监测鼻咽癌治疗疗效的临床意义.方法回顾分析2016-2017年间本院初诊的799例鼻咽癌根治性调强放疗患者的临床资料.分析疗前血浆EBV DNA与临床分期、肿瘤进展的相关性,比较放疗结束及随访中EBV DNA与肿瘤进展的关系.结果疗前DNA表达水平与临床分期、肿瘤进展呈正相关(P<0.001).放疗结束后6~8周,19例(2.3%)血浆EBV DNA持续阳性者预后最差,14例发生了肿瘤进展.9例放疗结束后6~8周转为EBV DNA阴性,3例肿瘤进展.而放疗结束EBV DNA阴性患者肿瘤进展率仅8.3%(64/772),3个组无肿瘤进展生存率不同(P<0.05).随访中持续性血浆EBV DNA阳性,诊断肿瘤进展的敏感性、特异性、准确性分别为77.6%、100%、98.1%.结论鼻咽癌患者疗前EBV DNA表达水平与肿瘤负荷和肿瘤进展相关,放疗结束6~8周EBV DNA持续阳性者预后极差,应给予合适的辅助治疗.随访中持续性血浆EBV DNA阳性诊断肿瘤进展的正确性高,是鼻咽癌根治性治疗后可靠的疗效监测指标.

Objective To investigate the clinical value of plasma EBV DNA in monitoring clinical efficacy in the treatment of nasopharyngeal carcinoma(NPC).Methods Clinical data of 799 patients initially diagnosed with NPC treated with radical intensity-modulated radiotherapy(IMRT)in our hospital from 2016 to 2017 were analyzed retrospectively.Prior to treatment,the correlation between plasma EBV DNA,clinical stage and tumor progression was analyzed.The relationship between EBV DNA and tumor progression was analyzed after radiotherapy and during follow-up.Results Before IMRT,the level of EBV DNA was positively correlated with both clinical stage and tumor progression(both P<0.001).At 6 to 8 weeks after IMRT,19(2.3%)patients positive for plasma EBV DNA obtained the worst prognosis and 14 cases had tumor progression.At 6-8 weeks after IMRT,9 patients were negative for EBV DNA and 3 cases had tumor progression.The tumor progression rate of patients with undetectable plasma EBV DNA at the end of IMRT was only 8.3%(64/772),and the progression-free survival rate significantly differed among three groups(all P<0.05).The sensitivity,specificity and accuracy rates of persistent positive plasma EBV DNA during follow-up were calculated as 77.6%,100%and 98.1%,respectively.Conclusions The level of plasma EBV DNA in patients with NPC is correlated with tumor bearing and tumor progression prior to IMRT.At 6-8 weeks after IMRT,patients who are persistently positive for EBV DNA obtain the worst prognosis and should be given with appropriate adjuvant therapy.The correlation between persistent positive plasma EBV DNA during follow up and tumor progression yields a high accuracy rate,indicating that plasma EBV DNA is a reliable biomarker for monitoring the clinical efficacy after radical treatment for NPC patients.