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Plasma Epstein-Barr Viral Deoxyribonucleic Acid Quantitation Complements Tumor-Node-Metastasis Staging Prognostication in Nasopharyngeal Carcinoma

Sing-fai Leung, Benny Zee, Brigette B. Ma, Edwin P. Hui, Frankie Mo, Maria Lai, K.C. Allen Chan, Lisa Y.S. Chan, Wing-hong Kwan, Y.M. Dennis Lo, Anthony T.C. Chan

From the Department of Clinical Oncology, Sir YK Pao Centre for Cancer, Centre for Clinical Trials, and Department of Chemical Pathology, The Chinese University of Hong Kong, Hong Kong, People's Republic of China

Address reprint requests to Anthony T.C. Chan, MD, Department of Clinical Oncology, Prince of Wales Hospital, Shatin, Hong Kong, China; e-mail: anthonytcchan{at}cuhk.edu.hk

PURPOSE: To evaluate the effect of combining circulating Epstein-Barr viral (EBV) DNA load data with TNM staging data in pretherapy prognostication of nasopharyngeal carcinoma (NPC).

PATIENTS AND METHODS: Three hundred seventy-six patients with all stages of NPC were studied. Pretreatment plasma/serum EBV DNA concentrations were quantified by a polymerase chain reaction assay. Determinants of overall survival were assessed by multivariate analysis. Survival probabilities of patient groups, segregated by clinical stage (I, II, III, or IV) alone and also according to EBV DNA load (low or high), were compared.

RESULTS: Pretherapy circulating EBV DNA load is an independent prognostic factor for overall survival in NPC. Patients with early-stage disease were segregated by EBV DNA levels into a poor-risk subgroup with survival similar to that of stage III disease and a good-risk subgroup with survival similar to stage I disease.

CONCLUSION: Pretherapy circulating EBV DNA load is an independent prognostic factor to International Union Against Cancer (UICC) staging in NPC. Combined interpretation of EBV DNA data with UICC staging data leads to alteration of risk definition of patient subsets, with improved risk discrimination in early-stage disease. Validation studies are awaited.

Supported in part by the Hong Kong Research Grants Council, the Kadoorie Charitable Foundation, and the Michael Kadoorie Cancer Genetics Research Programme.

Presented in part at the American Association for Cancer Research International Conference on Molecular Diagnostics in Cancer Therapeutic Development, September 12-15, 2006, Chicago, IL.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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