Unknown

Dataset Information

0

The plasma Epstein-Barr virus DNA level guides precision treatment for nasopharyngeal carcinoma in the intensity-modulated radiotherapy era: a large population-based cohort study from an endemic area.


ABSTRACT:

Background

In the intensity-modulated radiotherapy (IMRT) era, the survival benefit of concurrent chemotherapy for locoregionally advanced nasopharyngeal carcinoma (LA-NPC) remains undetermined. This study aimed to evaluate the benefits of IMRT with concurrent chemotherapy compared with IMRT alone for LA-NPC patients with different plasma Epstein-Barr virus (EBV) DNA levels.

Methods

Patients were identified from a prospectively maintained database in an endemic area between November 2002 and December 2013. Cox proportional hazards models, propensity score matching, and inverse probability weighting models were established for survival analysis. Stratification analysis was performed based on interaction effects analysis. Finally, sensitivity analysis was performed considering unmeasured confounders.

Results

A total of 1357 eligible patients were enrolled (median follow up 62.4 months; range 3.5-155.8 months). No significant survival differences were observed between groups in the entire cohort. Notably, a significant interaction effect was observed between treatment regimens and EBV DNA levels. In patients with high EBV DNA levels (>4000 copies/ml), all three models showed that IMRT with concurrent chemotherapy significantly improved overall survival [hazard ratio (HR) 2.521, 95% confidence interval (CI) 1.218-5.216], disease-free survival (HR 2.168, 95% CI 1.349-3.483), and distant metastasis-free survival (HR 2.331, 95% CI 1.194-4.551) compared with IMRT alone. No differences were found in patients with low EBV DNA levels. Sensitivity analysis confirmed the robustness of the results.

Conclusion

In the IMRT era, concurrent chemotherapy treatment of LA-NPC patients with high EBV DNA levels is reasonable. However, the optimal regimen for LA-NPC patients with low EBV DNA levels needs further validation in randomized clinical trials.

SUBMITTER: Liang H 

PROVIDER: S-EPMC6055246 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

altmetric image

Publications

The plasma Epstein-Barr virus DNA level guides precision treatment for nasopharyngeal carcinoma in the intensity-modulated radiotherapy era: a large population-based cohort study from an endemic area.

Liang Hu H   Lv Xing X   Wang Lin L   Wu Yi-Shan YS   Sun Rui R   Ye Yan-Fang YF   Ke Liang-Ru LR   Yang Qin Q   Yu Ya-Hui YH   Qiu Wen-Ze WZ   Liu Guo-Ying GY   Huang Xin-Jun XJ   Li Wang-Zhong WZ   Lv Shu-Hui SH   Guo Xiang X   Xiang Yan-Qun YQ   Xia Wei-Xiong WX  

Therapeutic advances in medical oncology 20180720


<h4>Background</h4>In the intensity-modulated radiotherapy (IMRT) era, the survival benefit of concurrent chemotherapy for locoregionally advanced nasopharyngeal carcinoma (LA-NPC) remains undetermined. This study aimed to evaluate the benefits of IMRT with concurrent chemotherapy compared with IMRT alone for LA-NPC patients with different plasma Epstein-Barr virus (EBV) DNA levels.<h4>Methods</h4>Patients were identified from a prospectively maintained database in an endemic area between Novemb  ...[more]

Similar Datasets

| S-EPMC4868751 | biostudies-literature
| S-EPMC7136458 | biostudies-literature
| S-EPMC6056955 | biostudies-literature
| S-EPMC6134827 | biostudies-other
| S-EPMC5858492 | biostudies-literature
| S-EPMC7020924 | biostudies-literature
| S-EPMC4770420 | biostudies-literature
| S-EPMC7386990 | biostudies-literature
| S-EPMC6763945 | biostudies-literature
| S-EPMC4395211 | biostudies-literature