1. The diagnostic and prognostic values of plasma Epstein-Barr virus DNA for residual cervical lymphadenopathy in nasopharyngeal carcinoma patients: a retrospective study
- Author
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Hu Liang, Li Ting Liu, Xiao Yun Li, Qing Nan Tang, Hai-Qiang Mai, Xue Song Sun, Chao Lin, Jin Jie Yan, Sai Lan Liu, Lin Quan Tang, Shan Shan Guo, Qiu Yan Chen, Yang Li, Ling Guo, Yu Jing Liang, Hao Jun Xie, and Huan Xin Lin
- Subjects
0301 basic medicine ,Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Epstein-Barr Virus Infections ,Herpesvirus 4, Human ,Survival ,medicine.medical_treatment ,Lymphadenopathy ,Gastroenterology ,lcsh:RC254-282 ,Fine needle aspiration cytology ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Cervical lymphadenopathy ,Internal medicine ,medicine ,Residual cervical lymphadenopathy ,Epstein-Barr virus ,Humans ,Aged ,Retrospective Studies ,Chemotherapy ,Nasopharyngeal Carcinoma ,Proportional hazards model ,business.industry ,Hazard ratio ,Neck dissection ,Retrospective cohort study ,Nasopharyngeal Neoplasms ,Middle Aged ,medicine.disease ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Prognosis ,Survival Analysis ,030104 developmental biology ,Real-time polymerase chain reaction ,Oncology ,Nasopharyngeal carcinoma ,030220 oncology & carcinogenesis ,DNA, Viral ,Original Article ,Female ,Lymph Nodes ,medicine.symptom ,business ,Neck - Abstract
Background Currently, the diagnosis and treatment of nasopharyngeal carcinoma (NPC) patients with residual cervical lymphadenopathy following radical radiotherapy with or without chemotherapy are challenging. We investigated the prognosis of NPC patients with residual cervical lymphadenopathy and assessed the diagnostic and prognostic values of Epstein-Barr virus (EBV) DNA in these patients. Methods This study included 82 NPC patients who were diagnosed with suspected residual cervical lymphadenopathy following completion of antitumor therapy. Their plasma EBV DNA levels were measured using quantitative polymerase chain reaction (qPCR) before the initiation of treatment and before neck dissection. Fine needle aspiration cytology (FNAC) was performed in 21 patients. All patients had undergone neck dissection and postoperative pathological examination to identify the nature of residual cervical lymphadenopathy. The overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRRFS) were calculated using the Kaplan–Meier method and compared using the log-rank test. The Cox proportional hazards model was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Multivariable analysis was used to estimate the effect of potential prognostic factors on survival. Results Following a median follow-up of 52.6 months, compared with patients with negative postoperative pathological findings for residual cervical lymphadenopathy, the patients with positive findings had a significantly lower 3-year PFS rate (49.9% vs. 83.3%, P = 0.008). Among NPC patients with residual cervical lymphadenopathy, the patients with preoperative plasma EBV DNA > 0 copy/mL had a lower 3-year PFS rate than did those with no detectable EBV DNA (43.7% vs. 61.1%, P = 0.031). In addition, combining FNAC with preoperative EBV DNA detection improved the diagnostic sensitivity. Multivariable analysis demonstrated that residual cervical lymphadenopathy with positive postoperative pathological result was an independent prognostic factor for PFS and that detectable preoperative plasma EBV DNA was an independent prognostic factor for OS. Conclusions Using FNAC combined with preoperative EBV DNA detection improves the sensitivity in diagnosing NPC with residual cervical lymphadenopathy. Compared with patients with undetectable EBV DNA, patients with detectable preoperative plasma EBV DNA have worse prognosis and may require a more aggressive treatment strategy.
- Published
- 2019