title: Nasopharyngeal Epstein-Barr Virus Load: An Efficient Supplementary Method for Population-Based Nasopharyngeal Carcinoma Screening.
abstract: Serological detection of Epstein-Barr virus (EBV) antibodies is frequently used in nasopharyngeal carcinoma (NPC) mass screening. However, the large number of seropositive subjects who require close follow-up is still a big burden. The present study aimed to detect the nasopharyngeal EBV load in a high-risk population seropositive for antibodies against EBV, as well as to examine whether assay for nasopharyngeal EBV DNA load might reduce the number of high-risk subjects for follow-up and improve early detection of NPC. A prospective and population-based cohort study was conducted in southern China from 2006 through 2013. Among 22,186 participants, 1045 subjects with serum immunoglobulin A (IgA) antibodies against viral capsid antigen (VCA) titers ≥ 1:5 were defined as high-risk group, and were then followed-up for NPC occurrence. Qualified nasopharyngeal swab specimens were available from 905 participants and used for quantitative PCR assay. Our study revealed that 89% (802/905) subjects showed positive EBV DNA in nasopharyngeal swab. The nasopharyngeal EBV load in females was higher than that in males. The nasopharyngeal EBV load increased with increasing serum VCA/IgA titers. Eight cases of newly diagnosed NPC showed an extremely elevated EBV load, and 87.5% (7 of 8 patients) were early-stage NPCs. The EBV loads of 8 NPCs were significantly higher than those of 897 NPC-free subjects (mean, 2.8 × 10(6) copies/swab [range 4.8 × 10(4)-1.1 × 10(8)] vs. 5.6 × 10(3) [range 0-3.8 × 10(6)]). Using mean EBV load in NPC-free population plus two standard deviations as cut-off value, a higher diagnostic performance was obtained for EBV load test than serum VCA/IgA test (area under ROC, 0.980 vs 0.895). In conclusion, in a prospective and population-based study we demonstrated that an additional assay of EBV load in the nasopharynx among high-risk individuals may reduce the number of subjects needed to be closely followed up and could serve as part of a NPC screening program in high-risk populations.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China; Key Laboratory of High-Incidence-Tumor Prevention & Treatment (Guangxi Medical University), Ministry of Education, Nanning, Guangxi, China; Department of Epidemiology, School of public health, Guangxi Medical University, Nanning, Guangxi, China.
authors.forename: Yufeng
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China; Department of Environmental and Molecular Medicine, Mie University Graduate School of Medicine, Mie, Japan.
authors.forename: Weilin
authors.initials: W
authors.lastname: Zhao
authors.affiliation: Key Laboratory of High-Incidence-Tumor Prevention & Treatment (Guangxi Medical University), Ministry of Education, Nanning, Guangxi, China; Department of Epidemiology, School of public health, Guangxi Medical University, Nanning, Guangxi, China.
authors.forename: Longde
authors.initials: L
authors.lastname: Lin
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
authors.forename: Xue
authors.initials: X
authors.lastname: Xiao
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
authors.forename: Xiaoying
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
authors.forename: Huixin
authors.initials: H
authors.lastname: Ming
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China; Key Laboratory of High-Incidence-Tumor Prevention & Treatment (Guangxi Medical University), Ministry of Education, Nanning, Guangxi, China.
authors.forename: Tingting
authors.initials: T
authors.lastname: Huang
authors.affiliation: Cancer Institute of Cangwu County, Wuzhou, Guangxi, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Liao
authors.affiliation: Cancer Institute of Cangwu County, Wuzhou, Guangxi, China.
authors.forename: Yancheng
authors.initials: Y
authors.lastname: Li
authors.affiliation: Key Laboratory of High-Incidence-Tumor Prevention & Treatment (Guangxi Medical University), Ministry of Education, Nanning, Guangxi, China; Department of Epidemiology, School of public health, Guangxi Medical University, Nanning, Guangxi, China.
authors.forename: Xiaoyun
authors.initials: X
authors.lastname: Zeng
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China; Key Laboratory of High-Incidence-Tumor Prevention & Treatment (Guangxi Medical University), Ministry of Education, Nanning, Guangxi, China.
authors.forename: Guangwu
authors.initials: G
authors.lastname: Huang
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Weimin
authors.initials: W
authors.lastname: Ye
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China; Key Laboratory of High-Incidence-Tumor Prevention & Treatment (Guangxi Medical University), Ministry of Education, Nanning, Guangxi, China.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000956:Antigens, Viral / Q000276:immunology; D019540:Area Under Curve; D002213:Capsid / Q000276:immunology; D002277:Carcinoma; D002681:China / Q000453:epidemiology; D004279:DNA, Viral / Q000097:blood; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D004854:Herpesvirus 4, Human / Q000276:immunology / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000276:immunology / Q000821:virology*; D012307:Risk Factors; D019562:Viral Load / Q000276:immunology
chemical_list: D000956:Antigens, Viral; D004279:DNA, Viral