Prognostic Significance of Plasma EB Virus-DNA Detaction in Patients with Recurrent Nasopharyngeal Carcinoma Before Salvage Therapy

WU Xiaofeng; ZHAO Jianhong; LI Siwei; WAN Long; WANG Shuibin

doi:10.13730/j.issn.2097-2148.2025.10.005

Abstract：Objective To investigate the predictive value of plasma Epstein-Barr virus(EBA)-deoxyribonucleic acid(DNA)detection before salvage therapy in patients with recurrent nasopharyngeal carcinoma(rNPC).Methods The clinical data of 92 patients with rNPC in author's hospital from July 2020 to December 2023 were retrospectively analyzed.Clinical baseline data,laboratory test data and 18 F-fluoro-2-deoxy-D-glucose positron emission tomography-computed tomography(18F-FDG-PET/CT)data of rNPC patients were collected.Blood samples were collected from patients before treatment,and plasma EBV-DNA levels were measured using real-time quantitative polymerase chain reaction.All patients were followed up and overall survival(OS)were recorded.The prognostic risk factors of rNPC and the predictive value of plasma EBV-DNA level for the prognosis of rNPC patients were analyzed.Results According to the recurrence pattern,92 rNPC patients were di-vided into local recurrence group(n=47)and distant recurrence group(n=45),19 patients(40.43％)died in the local recurrence group,while 31 patients(68.89％)died in the distant recurrence group,the median survival time of the two groups was 29.21 months and 20.34 months,respectively.Univariate analysis showed that the plasma EBV-DNA level at recurrence,the percentage of tumor node metastasis classification(TNM)stage Ⅳ,N stage 2-3,cytokeratin 19 fragment antigen 21-1(CYFRA21-1)level and squamous cell carcinoma antigen(SCC-Ag)level at recurrence were lower than those in the distant metastasis group,while the age and the percentage of TNM stage 3-4 were higher than those in the distant metastasis group,the differences between the two groups were statistically significant(all P＜0.05).Spearman correlation analysis showed that EBV-DNA level was positively correlated with the number of metastases(r=0.409,P=0.008)and maximal standard uptake value(SUVmax)(r=0.417,P=0.008)in the distant recurrence group;in the lo-cal recurrence group,EBV-DNA level was also positively correlated with local SUVmax(r=0.34,P=0.036).Cox re-gression analysis showed that serum carcino-embryonic antigen(CEA)at recurrence,SCC-Ag at recurrence and high log10EBVDNA at recurrence were independent risk factors for prognosis of rNPC patients,log10EBVDNA and distant SUVmax at recurrence were independent risk factors for prognosis of rNPC patients with distant recurrence.Receiver operating characteristic(ROC)curve analysis showed that the sensitivity of plasma EBV-DNA combined with traditional tumor markers CEA and SCC-Ag to predict the death of patients with local recurrence was 86.67％.area under the curve(AUC)was 0.827;the sensitivity of plasma EBV-DNA in predicting death of patients with distant recurrence was 94.12％,and AUC was 0.775,which were significantly higher than those of distant SUVmax(P=0.047).In patients with local recurrence and distant recurrence,the median OS of patients with high level of plasma EBV-DNA was shorter than that of patients with low level of plasma EBV-DNA(Log Rank x2 were 4.803 and 5.686,respectively,all P＜0.05).Conclusion Plasma EBV-DNA level can be used as an effective prognostic biomarker for overall survival in rNPC patients with both local recurrence and distant recurrence,and can be used for clinical prognostic risk stratification of rNPC patients.