The clinical value of the ratio of CRP to ALB before treatment combined with EBV DNA level in predicting the prognosis of patients with locally advanced nasopharyngeal carcinoma
DONG Xiaoli
DUAN Mingzhi
ZHANG Qun
Abstract：Objective To explore the value of the ratio of C-reactive protein to albumin(CAR)combined with Epstein-Barr virus DNA(EBV DNA)in predicting the prognosis of patients with locally advanced nasopharyngeal carcinoma(LA-NPC)receiving concurrent chemoradiotherapy(CCRT).Methods A total of 86 patients with LA-NPC admitted to Baoshan People's Hospital from January 2022 to December 2023 were retrospectively included.Data of C-reactive protein and albumin before treatment were collected to calculate CAR,and the level of plasma EBV DNA was detected by real-time fluorescence quantitative PCR(qPCR).The overall survival(OS),distant metastasis-free survival(DMFS),and progression-free survival(PFS)of the patients were followed up.The survival curve was plotted by the Kaplan-Meier method,and the survival difference was tested by Log-rank.Results During the follow-up period,local/regional recurrence occurred in 30 patients,distant metastasis occurred in 16 patients,and 7 patients died.The plasma EBV DNA levels[24 735.00(4 907.50,51 872.50)copies/mL]and CAR[3.16(2.12,5.04)]of the deceased patients were significantly higher than those of the survival group[950.00(600.00,3 597.50)copies/mL],Z=-2.960,P=0.003;0.18(0.07,0.72),Z=-5.018,P<0.001).The risk score was constructed based on the EBV DNA logarithmic transformation value and CAR,and was divided into the high-risk group(n=43)and the low-risk group(n=43)according to the cutoff value.The OS in the high-risk group was significantly worse(1-year survival rate:91.0%vs.100.0%;3-year survival rate:83.0%vs.100.0%;Log-rank χ2=8.129,P=0.004).The AUC of this model for predicting patient death,recurrence and metastasis was 0.902,0.797 and 0.817 respectively;time-dependent ROC showed that the AUC of its 1-year and 3-year predictive efficacy was both greater than 0.700.Plasma EBV DNA levels in LA-NPC patients with local/regional recurrence[5 235.00(627.50,37 462.50)vs.940.00(600.00,2 912.50)copies/mL;Z=-2.633,P=0.008 and the CAR value[1.87(0.43,3.86)vs.0.14(0.06,0.57);Z=-5.337,P<0.001]were significantly higher than those of patients without recurrence.The plasma EBV DNA level of LA-NPC patients with distant metastasis[5 235.00(3 327.50,43 217.50)vs.950.00(592.50,3,517.50)copies/mL;Z=-2.725,P=0.006)and CAR values[2.31(0.93,4.32)vs.0.18(0.07,0.89);Z=-4.206,P<0.001),both significantly higher than those of patients without distant metastasis.Conclusion The prognostic model constructed by CAR combined with EBV DNA has good clinical predictive value and can be used for individualized prognostic assessment of patients with LA-NPC.
Keywords：Nasopharyngeal carcinomaC-reactive protein/albumin ratioEBV deoxyribonucleic acid(EBV DNA)Concurrent chemoradiotherapyPrognosis
Publication Date：2025-09-28
Online Publishing Date：2025-10-28(First online date of this platform, not the publication date of the document)
Pages：7( 856-862 )