title: Circulating EBV DNA, Globulin and Nodal Size Predict Distant Metastasis after Intensity-Modulated Radiotherapy in Stage II Nasopharyngeal Carcinoma.
abstract: BACKGROUND
  The optimal treatment for early-stage nasopharyngeal carcinoma (NPC) remains controversial. Identification of prognostic factors for metastasis and tumor progression is urgently required to improve clinical decision-making for patients with American Joint Committee on Cancer (AJCC) 2009 stage II NPC from the endemic area.
  
  
  METHODS
  Consecutive newly-diagnosed patients (n=296) with non-disseminated, biopsy-proven stage II NPC were retrospectively reviewed; all patients received intensity-modulated radiotherapy and MRI follow-up. Plasma EBV DNA level, serum lactate dehydrogenase, serum albumin, serum globulin and leukocyte counts were measured before therapy. Survival rates were analyzed using the Kaplan-Meier method and log-rank test and multivariate Cox proportional hazards model.
  
  
  RESULTS
  Median follow-up was 50.2 months (range, 8-69.5 months). Multivariate analysis demonstrated a plasma Epstein-Barr virus (EBV) DNA level ≥ 4000 copies/mL, maximal axial diameter (MAD) of the cervical lymph nodes ≥ 30 mm and serum globulin level < 29.5 g/L were independent predictors of poor DMFS (P = 0.018; P = 0.019; P = 0.006, respectively). On the basis of these parameters, a prognostic model was developed as follows: 1) patients with no risk factors; 2) one risk factor; and 3) two or three risk factors. The 3-year distant metastasis-free survival rates for groups 1, 2 and 3 were 100%, 94.6% and 84.3%, respectively (P = 0.001).
  
  
  CONCLUSIONS
  The prognostic model based on EBV DNA, serum globulin and nodal size may facilitate individualized treatment of patients with stage II NPC at high risk of distant metastasis.
authors.affiliation: 1. Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Guangzhou 510060, China;
authors.forename: Xiao-Jing
authors.initials: XJ
authors.lastname: Du
authors.affiliation: 1. Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Guangzhou 510060, China;
authors.forename: Ling-Long
authors.initials: LL
authors.lastname: Tang
authors.affiliation: 1. Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Guangzhou 510060, China;
authors.forename: Yan-Ping
authors.initials: YP
authors.lastname: Mao
authors.affiliation: 1. Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Guangzhou 510060, China;
authors.forename: Rui
authors.initials: R
authors.lastname: Guo
authors.affiliation: 1. Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Guangzhou 510060, China;
authors.forename: Ying
authors.initials: Y
authors.lastname: Sun
authors.affiliation: 2. Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, No. 74 Zhongshan Road, Guangzhou 510060, China.
authors.forename: Ai-Hua
authors.initials: AH
authors.lastname: Lin
authors.affiliation: 1. Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Guangzhou 510060, China;
authors.forename: Jun
authors.initials: J
authors.lastname: Ma
keywords: Epstein-Barr virus DNA; metastasis; nasopharyngeal carcinoma.; nodal size; prognostic model; serum globulin