Proposed modifications and incorporation of plasma Epstein-Barr virus DNA improve the TNM staging system for Epstein-Barr virus-related nasopharyngeal carcinoma.
Background: The prognosis of patients who have Epstein-Barr virus (EBV)-related nasopharyngeal carcinoma (NPC) in which the tumor tissues harbor EBV have a better prognosis than those without EBV-related NPC. Therefore, the eighth edition of the TNM staging system could be modified for EBV-related N...
| Publicado en: | Cancer (0008543X) Vol. 125; no. 1; pp. 79 - 90 |
|---|---|
| Autores principales: | , , , , , , , , , , , , , , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Wiley-Blackwell
Jan2019
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=133686969&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 133686969 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 0008543X 23I jtl: Cancer (0008543X) issn: 0008543X maglogo: Y pubinfo: dt: Jan2019 vid: 125 iid: 1 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 133686969 133686969 NLM30351466 133686969 10.1002/cncr.31741 NLM30351466 133686969 ppf: 79 ppct: 11 formats: tig: atl: Proposed modifications and incorporation of plasma Epstein-Barr virus DNA improve the TNM staging system for Epstein-Barr virus-related nasopharyngeal carcinoma. aug: au: Guo, Rui Tang, Ling‐Long Mao, Yan‐Ping Du, Xiao‐Jing Chen, Lei Zhang, Zi‐Chen Liu, Li‐Zhi Tian, Li Luo, Xiao‐Tong Xie, Yu‐Bin Ren, Jian Sun, Ying Ma, Jun Tang, Ling-Long Mao, Yan-Ping Du, Xiao-Jing Zhang, Zi-Chen Liu, Li-Zhi Luo, Xiao-Tong Xie, Yu-Bin affil: Department of Radiation Oncology, Sun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou China sug: subj: DNA Blood Epstein-Barr Virus Infections Pathology Epstein-Barr Virus Nasopharyngeal Neoplasms Pathology Prospective Studies DNA Radiation Effects Nasopharyngeal Neoplasms Male Nasopharyngeal Neoplasms Radiotherapy Radiotherapy, Conformal Survival Analysis Human Retrospective Design Female Epstein-Barr Virus Infections Radiotherapy Neoplasm Staging Treatment Outcomes Prognosis Epstein-Barr Virus Radiation Effects Validation Studies Comparative Studies Evaluation Research Multicenter Studies Funding Source Male Female ab: Background: The prognosis of patients who have Epstein-Barr virus (EBV)-related nasopharyngeal carcinoma (NPC) in which the tumor tissues harbor EBV have a better prognosis than those without EBV-related NPC. Therefore, the eighth edition of the TNM staging system could be modified for EBV-related NPC by incorporating the measurement of plasma EBV DNA.Methods: In total, 979 patients with NPC who received intensity-modulated radiotherapy (IMRT) were retrospectively reviewed. Recursive partitioning analysis was conducted based on tumor (T) classification, lymph node (N) classification, and EBV DNA measurement to derive objectively the proposed stage groupings. The validity of the proposed stage groupings was confirmed in a prospective cohort of 550 consecutive patients who also received with IMRT.Results: The pretreatment plasma EBV DNA level was identified as a significant, negative prognostic factor for progression-free survival and overall survival in univariate analysis (all P < .001) and multivariate analysis (all P < .05). Recursive partitioning analysis of the primary cohort to incorporate EBV DNA generated the following proposed stage groupings: stage RI (T1N0), RIIA (T2-T3N0 or T1-T3N1, EBV DNA ≤2000 copies/mL), stage RIIB (T2-T3N0 or T1-T3N1, EBV DNA >2000 copies/mL; T1-T3N2, EBV DNA ≤2000 copies/mL), stage RIII (T1-T3N2, EBV DNA >2000 copies/mL; T4N0-N2), and stage RIVA (any T and N3). In the validation cohort, the 5-year progression-free survival rate was 100%, 87.9%, 76.7%, 68.7%, and 50.4% for proposed stage RI, RIIA, RIIB, RIII, and RIV NPC, respectively (P < .001). Compared with the eighth edition TNM stage groupings, the proposed stage groupings incorporating EBV DNA provided better hazard consistency, hazard discrimination, outcome prediction, and sample size balance.Conclusions: The proposed stage groupings have better prognostic performance than the eighth edition of the TNM staging system. EBV DNA titers should be included in the TNM staging system to assess patients who have EBV-related NPC. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|