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Purpose@#This retrospective study aimed to re-evaluate the effect of concurrent chemotherapy in patients with locally advanced nasopharyngeal carcinoma (NPC) in the era of intensity-modulated radiotherapy (IMRT). @*Materials and Methods@#A total of 498 patients who received neoadjuvant chemotherapy (NCT) combined with concurrent chemoradiotherapy (CCRT) or IMRT were retrospectively reviewed. The distribution of baseline characteristics was balanced using propensity score matching. Additionally, the results of NCT+IMRT and NCT+CCRT were compared using Kaplan-Meier survival analysis, and differences in survival rates were analyzed using the log rank test. @*Results@#There were no significant differences in overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and local progression-free survival (LRFS) between the two groups. Patients were further categorized into risk subgroups based on pretreatment Epstein-Barr virus (EBV) DNA cutoff values using receiver operating characteristic curve analysis. There were no statistically significant differences in OS, PFS, DMFS, and LRFS between patients who received NCT+CCRT and NCT+IMRT in the high-risk group. In the low-risk group, although there were no differences between NCT+CCRT and NCT+IMRT in OS, PFS, and LRFS, patients who received NCT+CCRT had better DMFS than those who received NCT+IMRT. @*Conclusion@#Pretreatment EBV DNA level can be used to individualize concurrent chemotherapy for patients with locally advanced NPC. Patients with low pretreatment EBV DNA levels may benefit from concurrent chemotherapy, whereas those with high levels may not. Other treatment modalities need to be explored for high-risk patients to improve their prognosis.
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Objective@#To investigate the clinical value of plasma EBV DNA in monitoring clinical efficacy in the treatment of nasopharyngeal carcinoma (NPC).@*Methods@#Clinical data of 799 patients initially diagnosed with NPC treated with radical intensity-modulated radiotherapy (IMRT) in our hospital from 2016 to 2017 were analyzed retrospectively. Prior to treatment, the correlation between plasma EBV DNA, clinical stage and tumor progression was analyzed. The relationship between EBV DNA and tumor progression was analyzed after radiotherapy and during follow-up.@*Results@#Before IMRT, the level of EBV DNA was positively correlated with both clinical stage and tumor progression (both P<0.001). At 6 to 8 weeks after IMRT, 19(2.3%) patients positive for plasma EBV DNA obtained the worst prognosis and 14 cases had tumor progression. At 6-8 weeks after IMRT, 9 patients were negative for EBV DNA and 3 cases had tumor progression. The tumor progression rate of patients with undetectable plasma EBV DNA at the end of IMRT was only 8.3%(64/772), and the progression-free survival rate significantly differed among three groups (all P<0.05). The sensitivity, specificity and accuracy rates of persistent positive plasma EBV DNA during follow-up were calculated as 77.6%, 100% and 98.1%, respectively.@*Conclusions@#The level of plasma EBV DNA in patients with NPC is correlated with tumor bearing and tumor progression prior to IMRT. At 6-8 weeks after IMRT, patients who are persistently positive for EBV DNA obtain the worst prognosis and should be given with appropriate adjuvant therapy. The correlation between persistent positive plasma EBV DNA during follow up and tumor progression yields a high accuracy rate, indicating that plasma EBV DNA is a reliable biomarker for monitoring the clinical efficacy after radical treatment for NPC patients.
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Objective To evaluate and compare the analytical performances and application values of three nucleic acid extraction methods for quantification of plasma Epstein-Barr Virus ( EBV ) DNA. Methods It used silica membrane spin column , boiling and automated magnetic bead method to extract viral nucleic acid in parallel , and combined real-time fluorescence quantitative PCR assays for quantitative EBV-DNA quantification.The performances of three methods were determined and compared by using the third-party reference materials , and the clinical values were analyzed by pairing detecting 100 NPC patients and 100 healthy subjects in pair .Results The accuracy and imprecision of three methods were all in line with requirements , and the results of clinical samples were linearly correlated . But actually the reproducibility and intermediate imprecision of the magnetic bead method were smaller and stable than those of the spin column method and the boiling method ( all <3％);the limit of detection for the magnetic bead method was 3.334 ×101 IU/ml, better than that of spin column method (4.159 ×101 IU/ml) and boiling method (8.511 ×101 IU/ml);the linear range of the magnetic bead method was 5.4 ×101 -5.4 ×105 IU/ml, slightly wider than that of the boiling method (5.4 ×102 -5.4 ×105 IU/ml); the ability of anti -Hb interference ability of magnetic bead method is better than that of boiling method ;and the positive rate and the mean viral load of the NPC samples measured with the magnetic bead method were significantly higher (95％, 8.342 ×103 IU/ml) than those measured with the spin column method (84％, 4.707 ×103 IU/ml) and the boiling method (78％, 2.571 ×103 IU/ml) ( P all<0.05).Conclusion The automated magnetic bead nucleic acid extraction method offered better analytical performance and higher clinical value for EBV DNA quantification in plasma .
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PURPOSE: To evaluate the prognosis of nasopharyngeal carcinoma (NPC) patients who developed bone-only metastasis after primary treatment and the stratification of these patients into different risk groups based on independent prognostic factors. MATERIALS AND METHODS: Eighty NPC patients who developed bone-only metastasis after definitive radiotherapy from October 2005 to December 2010 were enrolled. All these patients received palliative treatment for bone metastasis, including chemotherapy and/or radiotherapy. Clinical features, treatment modality, and laboratory parameters were examined with univariate and multivariate analyses. RESULTS: The median follow-up time was 15.5 months (range, 2-67 months) for the whole cohort. The median overall metastatic survival (OMS) time and the 2-year estimate OMS rate were 26.5 months and 52%, respectively. Multivariate analysis indicated that patients with short metastases-free interval, multiple bone metastases sites, high serum lactic dehydrogenase levels, and treated with radiotherapy or chemotherapy alone had significantly worse outcomes. Patients were stratified into three different risk groups based on the number of adverse factors present. The OMS curves of the three groups were all significantly different (p<0.001). CONCLUSION: Severl prognostic factors were found to be associated with worse outcomes. According to the number of adverse factors present, bone-only metastasis patients can be stratified into three risk groups with significantly different prognoses. Such grouping may help in improving the design of clinical trials and in guiding individualized treatment for NPC patients with bone-only metastasis.
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Bone Neoplasms/mortality , Combined Modality Therapy , Multivariate Analysis , Nasopharyngeal Neoplasms/mortality , Neoplasm Staging , Prognosis , Retrospective Studies , Survival RateABSTRACT
<p><b>OBJECTIVE</b>To analyze the prognosis and its influencing factors for nasopharyngeal carcinoma patients with distant metastasis after radical radiotherapy.</p><p><b>METHODS</b>Clinical data of 184 cases of nasopharyngeal carcinoma after radical radiotherapy with distant metastases were retrospectively reviewed and the factors affecting prognosis were analyzed.</p><p><b>RESULTS</b>The median survival time was 12 months for the whole group, and the 1-, 2-, and 3-year survival rates were 50.6%, 30.7% and 20.9%, respectively. Cox univariate analysis showed that the prognosis of patients with metastasis after radiotherapy was significantly related with The N stage, chemotherapy, time interval between the end of radiotherapy and occurrence of distant metastasis, metastatic sites, chemotherapy after metastasis, cycles of chemotherapy and palliative radiotherapy after metastasis (P<0.05), but not significantly related with sex, age, T stage, clinical stage, cycles of chemotherapy, radiation technique and radiation dose for initial treatment (P>0.05). Advanced N stage, no chemotherapy, short time interval between the end of radiotherapy and occurrence of distant metastasis, multiple metastases, no radiotherapy or chemotherapy for metastases were predictive for poor prognosis (P<0.05). Multivariable analysis indicated that factors including N stage at initial diagnosis, metastatic sites, whether or not chemotherapy was given, the time interval between the end of radiotherapy and the occurrence of distant metastasis were independent factors affecting the prognosis of nasopharyngeal carcinoma patients with distant metastasis after radiotherapy.</p><p><b>CONCLUSIONS</b>N stage at initial diagnosis, metastatic sites, whether or not chemotherapy was given, the time interval between the end of radiotherapy and the occurrence of distant metastasis are independent factors affecting the prognosis for nasopharyngeal carcinoma patients with distant metastasis after radiotherapy. Systemic chemotherapy and local palliative radiotherapy are the primary treatment for nasopharyngeal carcinoma patients with metastasis.</p>
Subject(s)
Humans , Carcinoma , Nasopharyngeal Neoplasms , Diagnosis , Radiotherapy , Neoplasm Staging , Prognosis , Retrospective Studies , Survival RateABSTRACT
Background and purpose: Cervical nodal metastasis in nasopharyngeal carcinoma plays an important role in the definition of radiotherapy area and clinical staging, it is also one of the main factors influencing prognosis. So this study was designed to explore the pattern of metastatic lymph nodes for patients with nasopharyngeal carcinoma, which may provide a basis for clinical treatment and research. Methods: From Jun. 2005 to Sep. 2007,779 histologically diagnosed nasopharyngeal carcinoma patients had routine MRI scan before radiation therapy at Fujian Provincial Cancer Hospital. Diagnostic radiologists and radiation oncoiogists together assessed the nodal distribution according to the guideline CT-hased delineation of lymph node levels. Then, Chi-sqnare test was used to analyze the correlation between T stage and nodal metastasis rate and between nodal diameter and nodal extracapsular invasion. Results: Of 779 patients, 592(76.0%) had nodal involvement. The distribution was as follows: 1 in level Ⅰ,384 in level Ⅱa, 499 in level Ⅱ_b, 184 in level Ⅲ, 33 in level Ⅳ, 67 in level V_a, 21 in level V_b, 597 in retropharynx.In these patients, a total of 1 479 postive nodes, including 973 (65.79%) extracapsular spread nodes, were detected.The rate of nodal extracapsular invasion was higher when the axial diameter increased. Leap metastasis rate was 1.0%. No significant correlation was found between T stage and nodal involvement. Conclusion: The level Ⅱ and retropharyngeal node were the most frequently involved regions, they had similar metastatic rate and were both the first echo node to metastases of nasopharyngeal carcinoma. Level Ⅰ metastasis was lower. The proportion of extracapsular spread of metastatic lymph nodes increased with axial diameter of lymph nodes-dependent. The cervical node involvement of nasopharyngeal carcinoma was spread orderly down the neck, and the incidence of skip metastasis is rare. The relationship between T stage and nodal involvement has no statistical significance.
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Objective To carry out a comparative study between the Chinese 2008 and'92 staging system of nasopharyngeal carcinoma (NPC). Methods A total of 777 patients presented with untreated nondisseminated NPC who had received MRI scan of nasopharynx and neck were studied retrospectively. The clinical materials and information of imaging were collected. All patients were restaged according to the Chinese 2008 and 92 staging system of nasopharyngeal carcinoma. Distribution of T, N stage, survival and prognostic value were compared. 513 patients of the 777 cases were treated with conventional radiotherapy,264 cases with intensity modulated radiation therapy. Results The 3-year follow-up rate was 97.6%. The consistency of T stages was 95.0%. T, N and clinical stage distributions in two systems were similar ( Kappa = 0. 93, P = 0. 000; Kappa = 0. 58, P = 0. 000; Kappa = 0. 74, P = 0. 000). Local failure-free survival and disease specific survival were also similar. There was no difference of distant metastasis between N0 and N1(x2 = 1.94,P=0. 164), and a marginal difference between N1 and N2(x2 =3.83,P=0.051) in the Chinese'92 staging system. However, although there was also no difference of distant metastasis-free survival between No and N1a(x2 =0. 07,P =0. 797), ) the difference of overall survival among N1b, N2, and N3 were significant ( x2 = 4. 95, P = 0. 026; x2 = 6. 74, P = 0. 009) in the Chinese 2008 staging system. Conventional radiotherapy or intensity modulated radiation therapy was not a prognostic factor for survival ( x2 = 3.60,P =0. 058). It is reasonable for the Chinese 2008 staging system integrated lymph node characteristics such as laterality, level and extranodal neoplastic spread into the N staging criteria ( x2 = 6. 59, P = 0. 010; x2 =4.78,P=0. 029;x2=9.32,P=0. 002). Conclusions For the Chinese 2008 staging system, it was reasonable to simplify the previous T stage. The N stage showed a better predictive role of distant failure.The role of retropharyngeal lymph node in stage system needs further investigation.
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Ideal tumor marker should have potential clinical values in early diagnosis, monitoring of the residual, recurrence and distant metastasis of the disease. It also plays a role in the prediction of prognosis of the disease and evaluation of its sensitivity to radiotherapy and chemoradiotherapy. The article reviewed the current status of research about the tumor marker related to nasopharyngeal carcinoma.