鼻咽癌患者血浆EBV-DNA检测的临床价值  

The Clinical significance of plasma Epstein-Barr virus DNA in nasopharyngeal carcinoma

作　　者：王惠丽 黄晓东[1] 曲媛[1] 王凯[1] 吴润叶[1] 张烨[1] 刘清峰[1] 张世平[1] 王憨杰 许潇天[1] 肖建平[1] 易俊林[1] 罗京伟[1] 徐国镇[1] 高黎[1] Wang Huili;Huang Xiaodong;Qu Yuan;Wand Kai;Wu Runye;Zhang Ye;Liu Qingfeng;Zhang Shiping;Wang Minjie;Xu Xiaotian;Xiao Jianping;Yi Junlin;Luo Jingwei;Xu Guozhen;Gao Li(Department of Radiation Oncology National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences ,Peking Union Medical College, Beijing 100021, China)

机构地区：[1]北京协和医学院国家癌症中心/中国医学科学院肿瘤医院放疗科,100021

出　　处：《中华放射肿瘤学杂志》2018年第6期543-547,共5页Chinese Journal of Radiation Oncology

基　　金：国家重大研发计划（2016YFC0904600）

摘　　要：目的 EB病毒与鼻咽癌的发生发展明确相关,多个研究显示血浆EBV-DNA对于鼻咽癌的诊断分期及预后判断有重要意义,因此对我院患者进行了血浆EBV-DNA的检测并分析其临床价值。方法 2013—2016年连续性鼻咽癌患者471例,分析其治疗前EBV-DNA水平与分期、肿瘤负荷的相关性,并对治疗前、治疗末EBV-DNA进行生存相关分析。结果 患者治疗前血浆EBV-DNA中位数137 copies/ml （0～494000）,与T分期、N分期、M分期、总的临床分期、肿瘤负荷均有明显统计学相关性。生存分析显示治疗前血浆EBV-DNA拷贝数≤1300组比〉1300组的患者有更好OS （P=0.007）、PFS （P=0.011）、DMFS （P=0.003）。治疗末血浆EBV-DNA不可检测到的患者有更好OS （P=0.016）、PFS （P=0.000）、DMFS （P=0.000）。Cox多因素分析T分期、治疗末是否可检测到EBV-DNA为OS （P=0.030、0.012）的预后因素,N分期（P=0.037、0.017）、放疗末是否可检测到EBV-DNA （P=0.006、0.001）为PFS及DMFS的预后因素。结论 鼻咽癌患者治疗前血浆EBV-DNA水平与分期及肿瘤负荷有明显相关性,治疗前EBV-DNA水平更高的患者可能治疗后的预后更差。治疗末血浆EBV-DNA是否可检测到对于OS、PFS、DMFS有较好的预测价值。Objective It has been confirmed that Epstein-Barr virus （EBV） is associated with the occurrence and development of the nasopharyngeal carcinoma （NPC）.We investigated the clinical significance of plasma concentrations of EBV-DNA in patients with NPC. Methods Since October,2013 to December,2016,471 patients were analyzed. The significantly associated between EBV-DNA before treatment and staging,tumor burden was analyzed. The survival rate of EBV-DNA before and after treatment was calculated. Results The median copies of pretreatment plasma EBV-DNA in patients is 137 copies,（range 0-494000）,which is correlated with T stage,N stage,M stage,clinical stage and tumor burden load and that is statistically significant. Overall survival （OS,P=0.007）,progression-free survival （PFS,P=0.011） and distant metastasis-free survival （DMFS,P=0.003） were significantly lower among patients with pretreatment plasma EBV-DNA more than 1300 copies/ml. Patients with detectable plasma EBV-DNA had significantly worse OS （P=0.016）,PFS （P=0.000） and DMFS （P=0.000） than patients with undetectable EBV-DNA after treatment. Cox multivariate analyze suggests that T stage and EBV-DNA after treatment were independent prognostic factors for OS,however the plasma EBV-DNA after treatment （P=0.006,0.001） and N stage （P=0.037,0.017） were independent prognostic factors for PFS and DMFS. Conclusions The plasma EBV-DNA level was significantly correlated with staging and tumor load before treatment in patients with NPC,and the prognosis of patients with higher copies before treatment could be worse. The plasma EBV-DNA after treatment is predictive for OS,PFS and DMFS.

关 键 词：鼻咽肿瘤 EB病毒-DNA水平 预后 

分 类 号：R730.43[医药卫生—肿瘤] R739.63[医药卫生—临床医学]