Nasopharynx cancer: marker combination boosts prognostic value in IMRT era

  • Du YY & al.
  • Cancer Med
  • 12 Sep 2019

  • curated by Brian Richardson, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Considering both pretreatment DNA levels of Epstein-Barr virus (EBV) and cervical node necrosis (CNN) can improve risk stratification in patients with nasopharyngeal carcinoma (NPC) undergoing intensity-modulated radiotherapy (IMRT).

Why this matters

  • Better prognostic tools can aid in patient treatment stratification.

Key results

  • 5-year OS was 92.6%, 5-year PFS was 85.0%, 5-year locoregional relapse-free survival was 95.4%, and 5-year distant metastasis-free survival (DMFS) was 90.1%.
  • High EBV DNA (>4000 copies/mL) was associated with poor OS (HR, 2.166; P=.005), PFS (HR, 1.619; P=.015), and DMFS (HR, 1.795; P=.018) in multivariate analysis.
  • CNN was associated with poor OS (HR, 1.927; P=.016), PFS (HR, 1.492; P=.014), and DMFS (HR, 1.661; P=.016) in multivariate analysis.
  • EBV DNA level and CNN were correlated (correlation coefficient, 0.324; P<.001>
  • Combined EBV DNA level and CNN status were independent prognostic factors for OS (P<.001 pfs and dmfs>

Study design

  • 607 patients with nonmetastatic NPC treated with IMRT±chemotherapy were analyzed for associations among CNN, EBV DNA, and outcomes.
  • Funding: National Key R&D Program of China; National Natural Science Foundation of China; Sun Yat-Sen University, Guangdong Province; Sci‐Tech Project Foundation, Guangzhou City; National Science & Technology Pillar Program; Cultivation Foundation; others.

 Limitations

  • Assessment of CNN by MRI, not biopsy.