治疗前血浆EBVDNA在调强放疗鼻咽癌患者预后中的意义  

Prognostic Value of Pre-treatment Plasma EBV DNA in Nasopharyngeal Carcinoma Patients Treated with Intensity-modulated Radiation Therapy

作　　者：宗井凤[1] 郑瑜宏[1] 翁友良[1] 陈荔莎[1] 许昀[1] 陈燕[1] 潘建基[1] 林少俊[1] 

机构地区：[1]福建省肿瘤医院,福建福州350014

出　　处：《肿瘤学杂志》2016年第10期810-815,共6页Journal of Chinese Oncology

基　　金：福建省自然科学基金(2014J01406);福建省医学创新课题(2015-CX-6);国家临床重点专科建设项目;福建省临床重点专科建设项目

摘　　要：[目的]探讨初治鼻咽癌患者治疗前血浆EBV DNA表达水平的预后价值。[方法]回顾分析667例初诊鼻咽癌接受根治性调强放疗患者的临床资料,分析治疗前血浆EBV DNA与临床分期、总生存的关系。以1500拷贝数/ml为临界值,将患者分为EBV DNA高表达者和低表达者。Kaplan-Meier法计算生存率并用Log-rank法检验,多因素分析采用Cox模型分析。[结果]Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者中EBV DNA〉0拷贝数/ml的比率分别为18.8%、34.4%、50.5%、66.4%。患者治疗前血浆EBV DNA的表达量与临床分期呈正相关（P〈0.001）。临床分期和EBV DNA是患者总生存的独立预后因素。Ⅲ期患者中,EBV高低者两组差别具有统计学意义（χ^2=4.084,P=0.043）,EBV DNA还是Ⅲ期患者总生存的独立预后因素。Ⅰ-Ⅱ期及Ⅳ期患者中,EBV DNA高低两组总生存率差别无统计学意义,但多因素分析发现,EBV DNA的绝对拷贝数是总生存的独立预后因素（P〈0.05）。[结论]治疗前血浆EBV DNA对于各期鼻咽癌患者均具有预后作用,对于Ⅲ期患者,以1500拷贝数/ml为临界值,可以较好地判断预后,但对于Ⅰ-Ⅱ期及Ⅳ期患者,还需要更多的研究以确定合适的临界值。[Objective] To investigate the prognostic value of pre-treatment plasma EBV DNA of treatment naive patients with nasopharyngeal carcinoma（NPC）. [Methods] Materials of 667 newly diagnosed NPC patients treated with intensity-modulated radiation therapy were collected retrospectively. Correlation analysis were conducted between the level of EBV DNA and clinical information such as clinical stage and overall survival（OS）. Using 1500 copies/ml as cut-off value,patients were divided into high EBV DNA expression group and low EBV DNA expression group.The Kaplan-Meier method was used in the calculation of survival. The statistical significance of differences among survival curves was analyzed using the log-rank test. [Results] The percentage of patients with EBV DNA0 copies/ml in Stage Ⅰ,Stage Ⅱ,Stage Ⅲ and Stage Ⅳ disease were18.8%,34.4%,50.5% and 66.4%,respectively. The pre-treatment plasma EBV DNA level was significantly correlated with clinical stage（P〈0.001）. Clinical stage and EBV DNA were all the independent factors of OS. For Stage Ⅲ disease,there was significant difference between patients with high or low EBV DNA expression（χ^2=4.084,P=0.043）. Moreover,EBV DNA was the independent factor of OS. For patients with Stage Ⅰ-Ⅱ or Stage Ⅳ,no significant difference was found between high and low EBV DNA expression group. However,multivariate analysis found that the absolute copy number of EBV DNA was an independent prognostic factor for OS（P〈0.05）. [Conclusion] The pre-treatment plasma EBV DNA has prognostic value for all stages of NPC patients.For Stage Ⅲ disease,EBV DNA can perfectly classify patients when using 1500 copies/ml as cutoff value. While for patients with Stage Ⅰ - Ⅱ or Stage IV disease,more studies are needed to confirm the proper cut-off value.

关 键 词：鼻咽肿瘤 EBV DNA 调强放疗 

分 类 号：R739.62[医药卫生—肿瘤]