title: Plasma Epstein-Barr viral deoxyribonucleic acid quantitation complements tumor-node-metastasis staging prognostication in nasopharyngeal carcinoma.
abstract: OBJECTIVE
  To evaluate the effect of combining circulating Epstein-Barr viral (EBV) DNA load data with TNM staging data in pretherapy prognostication of nasopharyngeal carcinoma (NPC).
  
  
  METHODS
  Three hundred seventy-six patients with all stages of NPC were studied. Pretreatment plasma/serum EBV DNA concentrations were quantified by a polymerase chain reaction assay. Determinants of overall survival were assessed by multivariate analysis. Survival probabilities of patient groups, segregated by clinical stage (I, II, III, or IV) alone and also according to EBV DNA load (low or high), were compared.
  
  
  RESULTS
  Pretherapy circulating EBV DNA load is an independent prognostic factor for overall survival in NPC. Patients with early-stage disease were segregated by EBV DNA levels into a poor-risk subgroup with survival similar to that of stage III disease and a good-risk subgroup with survival similar to stage I disease.
  
  
  CONCLUSIONS
  Pretherapy circulating EBV DNA load is an independent prognostic factor to International Union Against Cancer (UICC) staging in NPC. Combined interpretation of EBV DNA data with UICC staging data leads to alteration of risk definition of patient subsets, with improved risk discrimination in early-stage disease. Validation studies are awaited.
authors.affiliation: Department of Clinical Oncology, Sir YK Pao Centre for Cancer, Centre for Clinical Trials, Hong Kong, People's Republic of China.
authors.forename: Sing-fai
authors.initials: SF
authors.lastname: Leung
authors.forename: Benny
authors.initials: B
authors.lastname: Zee
authors.forename: Brigette B
authors.initials: BB
authors.lastname: Ma
authors.forename: Edwin P
authors.initials: EP
authors.lastname: Hui
authors.forename: Frankie
authors.initials: F
authors.lastname: Mo
authors.forename: Maria
authors.initials: M
authors.lastname: Lai
authors.forename: K C Allen
authors.initials: KC
authors.lastname: Chan
authors.forename: Lisa Y S
authors.initials: LY
authors.lastname: Chan
authors.forename: Wing-hong
authors.initials: WH
authors.lastname: Kwan
authors.forename: Y M Dennis
authors.initials: YM
authors.lastname: Lo
authors.forename: Anthony T C
authors.initials: AT
authors.lastname: Chan
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood*; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000821:virology; D004279:DNA, Viral / Q000097:blood*; D005260:Female; D004854:Herpesvirus 4, Human / Q000302:isolation & purification*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000821:virology*; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate; D019562:Viral Load
chemical_list: D014408:Biomarkers, Tumor; D004279:DNA, Viral