Identifying optimal candidates for local treatment of the primary tumor among patients with de novo metastatic nasopharyngeal carcinoma: a retrospective cohort study based on Epstein-Barr virus DNA level and tumor response to palliative chemotherapy

Xue-Song Sun, Li-Ting Liu, Sai-Lan Liu, Shan-Shan Guo, Yue-Feng Wen, Hao-Jun Xie, Qing-Nan Tang, Yu-Jing Liang, Xiao-Yun Li, Jin-Jie Yan, Jun Ma, Qiu-Yan Chen, Lin-Quan Tang, Hai-Qiang Mai, Xue-Song Sun, Li-Ting Liu, Sai-Lan Liu, Shan-Shan Guo, Yue-Feng Wen, Hao-Jun Xie, Qing-Nan Tang, Yu-Jing Liang, Xiao-Yun Li, Jin-Jie Yan, Jun Ma, Qiu-Yan Chen, Lin-Quan Tang, Hai-Qiang Mai

Abstract

Background: To evaluate the clinical outcome in patients with de novo metastatic nasopharyngeal carcinoma (NPC) treated or not treated with locoregional radiotherapy (LRRT) based on plasma Epstein-Barr virus (EBV) DNA level and tumor response after palliative chemotherapy (PCT).

Methods: From 2007 to 2016, 502 patients with de novo metastatic NPC were included in this study. All patients were treated with PCT and 315 patients received LRRT. Our primary study endpoint was overall survival (OS).

Results: EBV DNA was detected in 461 patients (91.8%) before treatment but was undetectable in 249 patients (49.6%) after PCT. Three hundred and seventeen patients (63.1%) achieved satisfactory response (complete response or partial response) to PCT. Both the post-PCT EBV DNA level and tumor response were independent prognostic factors. Among low-risk patients (patients with undetectable EBV DNA and satisfactory tumor response after PCT), the 3-year OS rate was 80.4% in LRRT-treated patients and 45.3% in patients not treated with LRRT (P < 0.001). Multivariate analyses demonstrated that LRRT was an independent prognostic factor of OS in the low-risk patients (P < 0.001). However, among the high-risk patients (patients with detectable EBV DNA and/or unsatisfactory response after PCT), no statistically significant survival differences were observed between the LRRT and non-LRRT groups.

Conclusions: EBV DNA level and tumor response after PCT both correlate with the prognosis of de novo metastatic NPC. In such cases, LRRT may benefit the patients with undetectable EBV DNA levels and satisfactory tumor response after PCT.

Keywords: Epstein–Barr virus DNA; Local treatment; Metastatic nasopharyngeal carcinoma; Radiotherapy; Survival; Tumor response.

Conflict of interest statement

Ethics approval and consent to participate

This retrospective study was approved by the Clinical Research Committee of Sun Yat-sen University Cancer Center. Patients were required to provide written informed consent before enrolling in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart of study patient inclusion
Fig. 2
Fig. 2
Kaplan–Meier OS curves in 502 patients with de novo metastatic NPC (a) Patients grouped according to EBV DNA level after PCT. b Patients grouped according to tumor response after PCT. c Patients grouped according to risk stratification
Fig. 3
Fig. 3
Comparison of OS of patients in the LRRT and non-LRRT group (a) Low-risk patients (patients with undetectable EBV DNA level and satisfactory tumor response post-PCT) (b) High-risk patients (patients with detectable EBV DNA level or/and unsatisfactory tumor response post-PCT) (c) Landmark analyses of overall survival for long-term survivors of ≥1 year in low risk group (d) Landmark analyses of overall survival for long-term survivors of ≥1 year in high risk group

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