鼻咽癌患者血浆EBV-DNA大样本及长期随访分析

Analysis on plasma EBV-DNA with large sample size and long-tem follow-up data of NPC patients

目的利用大样本、长时间随访的鼻咽癌(nasopharyngeal carcinoma,NPC)临床数据库,探究治疗前后血浆EBV DNA在预测NPC患者预后中的价值。方法选取医院首诊700例NPC患者的临床数据,回顾性分析治疗前及治疗后血浆EBV DNA对NPC生存预后的预测价值。结果 NPC患者中,治疗前血浆EBV DNA阳性率及载量显著高于健康对照组及治疗后(P <0.01)。NPC患者治疗前EBV DNA水平与肿瘤分期显著相关(P <0.01)。治疗前EBV DNA载量≥1500 copies/ml和治疗后EBV DNA阳性NPC患者的5年无进展生存率(PFS)、无远处转移生存率(DMFS)、无复发生存率(RFS)、总生存率(OS)分别较治疗前EBV DNA<1500 copies/ml和治疗后EBV DNA阴性患者更差(P <0.01),多因素分析显示治疗前EBV DNA≥1500 copies/ml(P <0.05)是NPC疾病进展的独立危险因素,而治疗后EBV DNA阳性则是PFS、DMFS、OS最重要的预后危险因素(P <0.01)。结论治疗前后血浆EBV DNA对NPC患者的生存预后均具有重要的预测价值,本研究结果可为NPC临床诊治、基础研究提供更多的数据和参考。

Objective To explore the value of pre-and post-treatment plasma Epstein-Barr virus(EBV)DNA in predicting the prognosis of patients with nasopharyngeal carcinoma(NPC)by using clinical database of large sample size and long-term follow-up NPC cases.Metfiods The clinical data of 700 patients who were first diagnosed with NPC in our hospital were selected,and the value of pre-and post-treatment plasma EBV DNA in predicting the survival and prognosis of NPC was retrospectively analyzed.Results Before the treatment,the positive rate and load of plasma EBV DNA of NPC patients were significantly higher than that of the healthy control group and that after treatment(P<0.01).The level of pre-treatment EBV DNA of NPC patients was significantly correlated with tumor staging(P<0.01).Compared with the patients who had EBV DNA load of less than 1500 copies/ml before the treatment and negative EBV DNA after the treatment,the NPC patients with EBV DNA load of no less than 1500 copies/ml before the treatment and positive EBV DNA after the treatment showed poorer performance in five-year progression-free survival(PFS),distant metastasis-free survival(DMFS),relapse-free survival(RFS)and overall survival(OS)(P<0.05).Multivariate analysis showed that"EBV DNA load no less than 1500 copies/ml before the treatment"was an independent risk factor for progression of NPC,and"positive EBV DNA after the treatment"was the most important risk factor for prognosis of PFS,DMFS and OS(P<0.01).Conclusion Pre-and post-treatment plasma EBV DNA are of great value in predicting both the survival and prognosis of NPC patients.The results of this study can provide more detailed data and reference for clinical diagnosis and treatment and basic research of NPC.