Can Epstein-Barr virus DNA load in nasopharyngeal brushings or whole blood predict recurrent nasopharyngeal carcinoma in a non-endemic region? A prospective nationwide study of the Dutch Head and Neck Oncology Cooperative Group.
This study estimated the value of quantitative measurements of EBV markers in the clinical management of nasopharyngeal carcinoma in a non-endemic area. The aim was to predict prognosis and detect recurrent and residual disease. In 72 patients, EBV DNA load in blood and nasopharyngeal brushes, and IgA VCA-p18 and EBNA1 in plasma were measured at different time points. At diagnosis and post-treatment, a cut-off value was used for detecting disease [positive (PPV) and negative (NPV) predictive value]. The markers were correlated as a continuous variable with tumor stage, disease-free survival (DFS) and overall survival (OS). The Cox hazard ratio model assessed hazard ratios. At diagnosis, the markers were above the COV in 45, 92, 85 and 83 % of the patients, respectively. Post-treatment, DNA load test in blood and brush had the best discriminating power (blood DNA load test: PPV 39 % and NPV 97 %, brush for local disease: PPV 75 % and NPV 99 %). Post-treatment, DNA load in blood was the best predictor for OS and DFS [hazard ratio 3.2 (95 % CI 1.51-3.5) and 2.3 (95 % CI 1.72-5.8)]. Assessing the EBV DNA load in blood has significant prognostic value, although the clinical value is for discussion. The EBV DNA load in the brush might improve early detection of local failures post-treatment.
Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, The Netherlands.
Sharon D
SD
Stoker
Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, The Netherlands.|Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands.
Maarten A
MA
Wildeman
Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands.
Zlata
Z
Novalic
Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, The Netherlands.
Renske
R
Fles
Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Vincent
V
van der Noort
Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
Remco
R
de Bree
Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Weibel W
WW
Braunius
Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.
Guido B
GB
van den Broek
Department of Radiotherapy, Institute for Radiation Oncology, Arnhem, The Netherlands.
Bas
B
Kreike
Department of Otolaryngology-Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
Kenneth W
KW
Kross
Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands.
Hedy
H
Juwana
Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands.
Octavia
O
Ramayanti
Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands.
Sandra A W M
SA
Verkuijlen
Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Jan Paul
JP
de Boer
Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands.
Astrid E
AE
Greijer
Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands.
Jaap M
JM
Middeldorp
Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, The Netherlands. I.Tan@nki.nl.|Department of Oral and Maxillofacial Surgery, Academic Medical Centre, Amsterdam, The Netherlands. I.Tan@nki.nl.|Department of Otorhinolaryngology, Gadjah Mada University, Yogyakarta, Indonesia. I.Tan@nki.nl.
I Bing
IB
Tan
D000328:Adult; D000368:Aged; D004279:DNA, Viral / Q000097:blood / Q000302:isolation & purification*; D018572:Disease-Free Survival; D042241:Early Diagnosis; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis; D019309:Epstein-Barr Virus Nuclear Antigens / Q000097:blood; D005260:Female; D004854:Herpesvirus 4, Human / Q000235:genetics* / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000821:virology*; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000821:virology*; D018365:Neoplasm, Residual; D009426:Netherlands; D011379:Prognosis; D011446:Prospective Studies; D019562:Viral Load
D004279:DNA, Viral; D019309:Epstein-Barr Virus Nuclear Antigens; C417029:EBV-encoded nuclear antigen 1
Diagnostic markers; Epstein-Barr virus; Nasopharyngeal carcinoma