title: The clinical utility of plasma Epstein-Barr virus DNA assays in nasopharyngeal carcinoma: the dawn of a new era?: a systematic review and meta-analysis of 7836 cases.
abstract: In this study, we assessed the potential of plasma Epstein-Barr virus (EBV) DNA assays to predict clinical outcomes in a large sample of nasopharyngeal carcinoma (NPC) patients and proposed a risk stratification model based on standardized EBV DNA load monitoring.We conducted a meta-analysis of 14 prospective and retrospective comparative studies (n = 7 836 patients) to evaluate the correlation between pretreatment plasma EBV DNA (pre-DNA), midtreatment plasma EBV DNA (mid-DNA), posttreatment plasma EBV DNA (post-DNA), the half-life value of plasma EBV DNA clearance rate (t1/2), and clinical outcomes. Our primary endpoint was overall survival (OS). Our secondary endpoints were progression-free survival (PFS), distant-metastasis-free survival (DMFS), and local-regional-failure-free survival (LRFS).High pre-DNA, detectable mid-DNA, detectable post-DNA, and slow EBV DNA clearance rates were all significantly associated with poorer OS, with hazard radios (HRs) equal to 2.81, 3.29, 4.26, and 3.58, respectively. Pre-DNA, mid-DNA, and post-DNA had the same effects on PFS, DMFS, and LRFS.Plasma EBV DNA assays are highly prognostic of long-term survival and distant metastasis in NPC patients. Based on the results of this meta-analysis, we propose a 4-grade systematic risk stratification model. Given the inherent limitations of the included studies, future well-designed randomized clinical trials are required to confirm to the findings of this analysis and to contribute to the development of individualized treatment strategies for NPC patients.
authors.affiliation: From the Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Canton, Guangdong Province, People's Republic of China.
authors.forename: Wenna
authors.initials: W
authors.lastname: Zhang
authors.forename: Yupei
authors.initials: Y
authors.lastname: Chen
authors.forename: Lei
authors.initials: L
authors.lastname: Chen
authors.forename: Rui
authors.initials: R
authors.lastname: Guo
authors.forename: Guanqun
authors.initials: G
authors.lastname: Zhou
authors.forename: Linglong
authors.initials: L
authors.lastname: Tang
authors.forename: Yanping
authors.initials: Y
authors.lastname: Mao
authors.forename: Wenfei
authors.initials: W
authors.lastname: Li
authors.forename: Xu
authors.initials: X
authors.lastname: Liu
authors.forename: Xiaojing
authors.initials: X
authors.lastname: Du
authors.forename: Ying
authors.initials: Y
authors.lastname: Sun
authors.forename: Jun
authors.initials: J
authors.lastname: Ma
mesh_terms: D002277:Carcinoma; D004279:DNA, Viral / Q000097:blood*; D004268:DNA-Binding Proteins; D020031:Epstein-Barr Virus Infections / Q000097:blood* / Q000150:complications; D004854:Herpesvirus 4, Human / Q000235:genetics*; D006801:Humans; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000821:virology; D063868:Patient Outcome Assessment; D011379:Prognosis; D014764:Viral Proteins
chemical_list: D004279:DNA, Viral; D004268:DNA-Binding Proteins; C091945:H5R protein, Vaccinia virus; D014764:Viral Proteins