title: The impact of plasma Epstein-Barr virus DNA and fibrinogen on nasopharyngeal carcinoma prognosis: an observational study.
abstract: BACKGROUND
  The impact of combining plasma fibrinogen levels with Epstein-Barr Virus DNA (EBV DNA) levels on the prognosis for patients with nasopharyngeal carcinoma (NPC) was evaluated.
  
  
  METHODS
  In this observational study, 2563 patients with non-metastatic NPC were evaluated for the effects of circulating plasma fibrinogen and EBV DNA levels on disease-free survival (DFS), distant metastasis-free survival (DMFS), and overall survival (OS).
  
  
  RESULTS
  Compared with the bottom biomarker tertiles, TNM stage-adjusted hazard ratios (HR, 95% confidence intervals (CIs)) for predicting DFS in fibrinogen tertiles 2 to 3 were 1.26 (1.00 to 1.60) and 1.81 (1.45 to 2.26), respectively; HR for EBV DNA tertiles 2 to 3 were 1.49 (1.12 to 1.98) and 4.24 (3.27 to 5.49), respectively. After additional adjustment for established risk factors, both biomarkers were still associated (P for trend <0.001) with reduced DFS (HR: 1.79, 95% CI, 1.43 to 2.25 for top fibrinogen tertiles; HR: 4.04, 95% CI: 3.10 to 5.27 for top EBV DNA tertiles compared with the bottom tertiles). For patients with advanced-stage disease, those with high fibrinogen levels (3.34 g l(-1)) presented with worse DFS, regardless of EBV DNA 4000 or <4000 copies ml(-1) subgroup. Similar findings were observed for DMFS and OS.
  
  
  CONCLUSIONS
  Circulating fibrinogen and EBV DNA significantly correlate with NPC patients survival. Combined fibrinogen and EBV DNA data lead to improved prognostic prediction in advanced-stage disease.
authors: 1] Sun Yat-sen University CancerCenter, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China [2] Department of Nasopharyngeal Carcinoma, 651 Dongfeng Road East, Guangzhou 510060, China.
authors: L-Q
authors: LQ
authors: Tang
authors: 1] Sun Yat-sen University CancerCenter, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China [2] Department of Nasopharyngeal Carcinoma, 651 Dongfeng Road East, Guangzhou 510060, China.
authors: Q-Y
authors: QY
authors: Chen
authors: 1] Sun Yat-sen University CancerCenter, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China [2] Department of Nasopharyngeal Carcinoma, 651 Dongfeng Road East, Guangzhou 510060, China.
authors: S-S
authors: SS
authors: Guo
authors: 1] Sun Yat-sen University CancerCenter, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China [2] Department of Clinical Laboratory, 651 Dongfeng Road East, Guangzhou 510060, China.
authors: W-H
authors: WH
authors: Chen
authors: 1] Sun Yat-sen University CancerCenter, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China [2] Department of Information Technology, 651 Dongfeng Road East, Guangzhou 510060, China.
authors: C-F
authors: CF
authors: Li
authors: 1] Sun Yat-sen University CancerCenter, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China [2] Department of Nasopharyngeal Carcinoma, 651 Dongfeng Road East, Guangzhou 510060, China.
authors: L
authors: L
authors: Zhang
authors: ZhongShan School of Medicine, Sun Yat-sen University, 651 Dongfeng Road East, Guangzhou 510060, China.
authors: X-P
authors: XP
authors: Lai
authors: ZhongShan School of Medicine, Sun Yat-sen University, 651 Dongfeng Road East, Guangzhou 510060, China.
authors: Y
authors: Y
authors: He
authors: ZhongShan School of Medicine, Sun Yat-sen University, 651 Dongfeng Road East, Guangzhou 510060, China.
authors: Y-X-X
authors: YX
authors: Xu
authors: ZhongShan School of Medicine, Sun Yat-sen University, 651 Dongfeng Road East, Guangzhou 510060, China.
authors: D-P
authors: DP
authors: Hu
authors: ZhongShan School of Medicine, Sun Yat-sen University, 651 Dongfeng Road East, Guangzhou 510060, China.
authors: S-H
authors: SH
authors: Wen
authors: ZhongShan School of Medicine, Sun Yat-sen University, 651 Dongfeng Road East, Guangzhou 510060, China.
authors: Y-T
authors: YT
authors: Peng
authors: 1] Sun Yat-sen University CancerCenter, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China [2] Department of Nasopharyngeal Carcinoma, 651 Dongfeng Road East, Guangzhou 510060, China.
authors: H
authors: H
authors: Liu
authors: 1] Sun Yat-sen University CancerCenter, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China [2] Department of Nasopharyngeal Carcinoma, 651 Dongfeng Road East, Guangzhou 510060, China.
authors: L-T
authors: LT
authors: Liu
authors: 1] Sun Yat-sen University CancerCenter, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China [2] Department of Pathology, 651 Dongfeng Road East, Guangzhou 510060, China.
authors: S-M
authors: SM
authors: Yan
authors: 1] Sun Yat-sen University CancerCenter, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China [2] Department of Nasopharyngeal Carcinoma, 651 Dongfeng Road East, Guangzhou 510060, China.
authors: L
authors: L
authors: Guo
authors: 1] Sun Yat-sen University CancerCenter, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China [2] Department of Nasopharyngeal Carcinoma, 651 Dongfeng Road East, Guangzhou 510060, China.
authors: C
authors: C
authors: Zhao
authors: 1] Sun Yat-sen University CancerCenter, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China [2] Department of Nasopharyngeal Carcinoma, 651 Dongfeng Road East, Guangzhou 510060, China.
authors: K-J
authors: KJ
authors: Cao
authors: 1] Sun Yat-sen University CancerCenter, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China [2] Department of Statistics and Epidemiology, 651 Dongfeng Road East, Guangzhou 510060, China.
authors: Q
authors: Q
authors: Liu
authors: 1] Sun Yat-sen University CancerCenter, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China [2] Department of Nasopharyngeal Carcinoma, 651 Dongfeng Road East, Guangzhou 510060, China.
authors: C-N
authors: CN
authors: Qian
authors: 1] Sun Yat-sen University CancerCenter, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China [2] Department of Radiation Oncology, 651 Dongfeng Road East, Guangzhou 510060, China.
authors: J
authors: J
authors: Ma
authors: 1] Sun Yat-sen University CancerCenter, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China [2] Department of Nasopharyngeal Carcinoma, 651 Dongfeng Road East, Guangzhou 510060, China.
authors: X
authors: X
authors: Guo
authors: Sun Yat-sen University CancerCenter, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China.
authors: M-S
authors: MS
authors: Zeng
authors: 1] Sun Yat-sen University CancerCenter, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China [2] Department of Nasopharyngeal Carcinoma, 651 Dongfeng Road East, Guangzhou 510060, China.
authors: H-Q
authors: HQ
authors: Mai
mesh_terms: D000328:Adult; D014408:Biomarkers, Tumor / Q000097:blood*; D002277:Carcinoma / Q000097:blood* / Q000473:pathology / Q000821:virology; D004279:DNA, Viral / Q000097:blood*; D018572:Disease-Free Survival; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D005500:Follow-Up Studies; D004854:Herpesvirus 4, Human / Q000235:genetics*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000097:blood* / Q000473:pathology / Q000821:virology; D009364:Neoplasm Recurrence, Local / Q000097:blood* / Q000821:virology; D009367:Neoplasm Staging; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor; D004279:DNA, Viral; D005340:Fibrinogen