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Plasma Epstein-Barr Virus DNA and Risk of Future Nasopharyngeal Cancer.

Authors :
Chan KCA
Lam WKJ
King A
Lin VS
Lee PPH
Zee BCY
Chan SL
Tse IOL
Tsang AFC
Li MZJ
Jiang P
Ai QYH
Poon DMC
Au KH
Hui EP
Ma BBY
Van Hasselt AC
Chan ATC
Woo JKS
Lo YMD
Source :
NEJM evidence [NEJM Evid] 2023 Jul; Vol. 2 (7), pp. EVIDoa2200309. Date of Electronic Publication: 2023 Jun 27.
Publication Year :
2023

Abstract

BACKGROUND: We previously conducted a prospective study to show that nasopharyngeal cancer (NPC) screening with circulating Epstein–Barr virus (EBV) DNA analysis can improve survival. However, the long-term significance of positive results in individuals without cancer was unclear. METHODS: We conducted a second-round screening at a median of 43 months after the initial screening. Participants with detectable plasma EBV DNA were retested in 4 weeks, and those with persistently positive results were investigated with nasal endoscopy and magnetic resonance imaging. RESULTS: Of the 20,174 volunteers who participated in the first-round screening, 17,838 (88.6%) were rescreened. Among them, 423 (2.37%) had persistently detectable plasma EBV DNA. Twenty-four patients were identified as having NPC. A significantly higher proportion of patients had stage I/II cancer than in a historical cohort (67% vs. 20%; chi-square test, P<0.001), and they had superior 3-year progression-free survival (100% vs. 78.8%). Compared with participants with undetectable plasma EBV DNA in the first round of screening, participants with transiently and persistently positive results in the first round were more likely to have a cancer identified in the second round, with relative risks of 4.4 (95% confidence interval, 1.3 to 15.0) and 16.8 (95% confidence interval, 5.7 to 49.6), respectively. CONCLUSIONS: Individuals with detectable plasma EBV DNA but without an immediately identifiable NPC were more likely to have the cancer identified in another round of screening performed 3 to 5 years later. (Funded by Kadoorie Charitable Foundation and others; ClinicalTrials.gov number, NCT02063399.)

Details

Language :
English
ISSN :
2766-5526
Volume :
2
Issue :
7
Database :
MEDLINE
Journal :
NEJM evidence
Publication Type :
Academic Journal
Accession number :
38320164
Full Text :
https://doi.org/10.1056/EVIDoa2200309