Survival Analysis of Patients With Advanced-Stage Nasopharyngeal Carcinoma According to the Epstein-Barr Virus Status

Oncotarget. 2016 Apr 26;7(17):24208-16. doi: 10.18632/oncotarget.8144.

Abstract

Purpose: The main aim of this study is to analyze the prognostic differences in nasopharyngeal carcinoma (NPC) patients who are positive and negative for Epstein-Barr virus (EBV).

Results: Of the 1106 patients, 248 (22.4%) had undetectable pre-treatment plasma EBV DNA levels. The total distant metastasis rate for EBV-negative group vs. EBV-positive group were 3.6% (9/248) vs. 15.0% (128/858) (P < 0.001). The estimated 4-year disease-free survival (DFS), overall survival (OS), distant metastasis-free survival (DMFS) and locoregional relapse-free survival (LRRFS) for EBV-negative group vs. EBV-positive group were 88.9% vs. 76.9% (P < 0.001), 93.6% vs. 85.9% (P = 0.001), 96.7% vs. 84.8% (P < 0.001) and 94.1% vs. 90.0% (P = 0.1), respectively. Multivariate analysis revealed that the EBV status was an independent prognostic factor for DFS (HR, 1.813; 95% CI, 1.219-2.695; P = 0.003), OS (HR, 1.828; 95% CI, 1.075-3.107; P = 0.026) and DMFS (HR, 3.678; 95% CI, 1.859-7.277; P <0.001), and overall stage still remained the most important prognostic factor in patients with stage III-IVB NPC.

Methods and materials: Data on 1106 patients with non-metastatic, histologically proven advanced-stage (III-IVB) NPC who underwent intensity-modulated radiotherapy (IMRT) were retrospectively reviewed. Patient survival between different EBV status groups were compared.

Conclusions: EBV status was an independent prognostic factor for patients with stage III-IVB NPC. Neoadjuvant chemotherapy (NCT) plus concurrent chemoradiotherapy (CCRT) should be better treatment regimen for EBV-positive patients since distant metastasis was the main failure pattern, and CCRT may be enough for EBV-negative patients.

Keywords: Epstein-Barr virus; advanced stage; intensity-modulated radiation therapy; nasopharyngeal carcinoma; prognosis.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Carcinoma / mortality*
  • Carcinoma / pathology
  • Carcinoma / therapy
  • Carcinoma / virology
  • Chemoradiotherapy / mortality*
  • Epstein-Barr Virus Infections / mortality*
  • Epstein-Barr Virus Infections / pathology
  • Epstein-Barr Virus Infections / therapy
  • Epstein-Barr Virus Infections / virology
  • Female
  • Follow-Up Studies
  • Herpesvirus 4, Human / pathogenicity
  • Humans
  • Male
  • Middle Aged
  • Nasopharyngeal Carcinoma
  • Nasopharyngeal Neoplasms / mortality*
  • Nasopharyngeal Neoplasms / pathology
  • Nasopharyngeal Neoplasms / therapy
  • Nasopharyngeal Neoplasms / virology
  • Neoadjuvant Therapy / mortality*
  • Prognosis
  • Radiotherapy, Intensity-Modulated / mortality*
  • Retrospective Studies
  • Survival Rate
  • Young Adult