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Neo J, Yip PL, Ong EHW, Miao J, Chow WM, Wee JTS, Fong KW, Soong YL, Tan TWK, Tan JSH, Sin SY, Liu J, Loh KS, Tay JK, Ang MK, Tan SH, Lim DWT, Chua MLK. Longitudinal post-radiotherapy plasma Epstein-Barr virus DNA trends inform on optimal risk stratification in endemic nasopharyngeal carcinoma. Oral Oncol 2024; 148:106655. [PMID: 38056062 DOI: 10.1016/j.oraloncology.2023.106655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVES To characterize longitudinal changes in Epstein-Barr virus (EBV) DNA post-radiotherapy in nasopharyngeal carcinoma (NPC) patients, and investigate whether an early (0-2 weeks) or delayed (8-12 weeks) EBV DNA result better predicts for disease-free survival (DFS). MATERIALS AND METHODS Histologically-confirmed NPC patients with ≥1 EBV DNA test quantified using the harmonized BamHI-W polymerase chain reaction-based assay at 0-2 and 8-12 weeks post-radiotherapy were included. RESULTS We identified 302 patients with EBV DNA measured at 0-2 weeks post-radiotherapy; of which, 110 (36.4 %) underwent a repeat test at 8-12 weeks post-treatment. Patients harboring a detectable EBV DNA at 0-2 weeks experienced an inferior DFS (adjusted HR1-264 copies 1.72 [95 %CI: 1.05-2.83], P = 0.031; AHR≥265 copies 4.39 [95 %CI: 1.68-11.44], P = 0.002 relative to 0 copies/mL). At 8-12 weeks, we observed substantial shifts in EBV DNA readings from 0 to 2 weeks; 76/110 (69.1 %) and 34/110 (30.9 %) patients at 0-2 weeks versus 90/110 (81.8 %) and 20/110 (18.2 %) at 8-12 weeks recorded undetectable and detectable EBV DNA, respectively. Positive EBV DNA at 8-12 weeks was strongly associated with relapse (73.3 % [11/15] for 1-264; 80.0 % [4/5] for ≥265 subgroups had relapses versus 15.6 % [14/90] for 0 copies/mL). Area under receiver operating curve values for 2-year relapse rates were 0.817 (95 %CI: 0.725-0.909) for stage + EBV DNA8-12w versus 0.654 (95 %CI: 0.542-0.765) for stage + EBV DNA0-2w. CONCLUSION: EBV DNA is dynamic post-radiotherapy, and delayed EBV DNA testing better enriched for higher-risk NPC patients. This implicates trials investigating adjuvant chemotherapy intensification based on early EBV DNA testing.
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Affiliation(s)
- Jialing Neo
- Division of Medical Sciences, National Cancer Centre Singapore, 30 Hospital Blvd, 168583, Singapore
| | - Pui Lam Yip
- Department of Radiation Oncology, National University Cancer Institute Singapore, 5 Lower Kent Ridge Road, 119074, Singapore
| | - Enya H W Ong
- Division of Medical Sciences, National Cancer Centre Singapore, 30 Hospital Blvd, 168583, Singapore
| | - Jingjing Miao
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong 510060, PR China
| | - Wen Min Chow
- Division of Medical Sciences, National Cancer Centre Singapore, 30 Hospital Blvd, 168583, Singapore
| | - Joseph T S Wee
- Division of Radiation Oncology, National Cancer Centre Singapore, 30 Hospital Blvd, 168583, Singapore
| | - Kam Weng Fong
- Division of Radiation Oncology, National Cancer Centre Singapore, 30 Hospital Blvd, 168583, Singapore
| | - Yoke Lim Soong
- Division of Radiation Oncology, National Cancer Centre Singapore, 30 Hospital Blvd, 168583, Singapore
| | - Terence W K Tan
- Division of Radiation Oncology, National Cancer Centre Singapore, 30 Hospital Blvd, 168583, Singapore
| | - Janice S H Tan
- Division of Radiation Oncology, National Cancer Centre Singapore, 30 Hospital Blvd, 168583, Singapore
| | - Sze Yarn Sin
- Division of Radiation Oncology, National Cancer Centre Singapore, 30 Hospital Blvd, 168583, Singapore
| | - Jianjun Liu
- Laboratory of Human Genomics, Genome Institute of Singapore, A Star, 60 Biopolis St, 138672, Singapore; Department of Psychological Medicine, Yong Loo Lin School of Medicine, 10 Medical Dr, 117597, Singapore
| | - Kwok Seng Loh
- Department of Otolaryngology - Head & Neck Surgery, National University of Singapore, 5 Lower Kent Ridge Road, 119074, Singapore; Division of Surgical Oncology, National University Cancer Institute, 5 Lower Kent Ridge Road, 119074, Singapore
| | - Joshua K Tay
- Department of Otolaryngology - Head & Neck Surgery, National University of Singapore, 5 Lower Kent Ridge Road, 119074, Singapore; Division of Surgical Oncology, National University Cancer Institute, 5 Lower Kent Ridge Road, 119074, Singapore
| | - Mei Kim Ang
- Division of Medical Oncology, National Cancer Centre Singapore, 30 Hospital Blvd, 168583, Singapore
| | - Sze Huey Tan
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, 30 Hospital Blvd, 168583, Singapore; Oncology Academic Programme, Duke-NUS Medical School, 8 College Road, 169857, Singapore
| | - Darren W T Lim
- Division of Medical Sciences, National Cancer Centre Singapore, 30 Hospital Blvd, 168583, Singapore; Division of Medical Oncology, National Cancer Centre Singapore, 30 Hospital Blvd, 168583, Singapore; Oncology Academic Programme, Duke-NUS Medical School, 8 College Road, 169857, Singapore
| | - Melvin L K Chua
- Division of Medical Sciences, National Cancer Centre Singapore, 30 Hospital Blvd, 168583, Singapore; Division of Radiation Oncology, National Cancer Centre Singapore, 30 Hospital Blvd, 168583, Singapore; Oncology Academic Programme, Duke-NUS Medical School, 8 College Road, 169857, Singapore.
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Zhang C, Zhan Z, Fang Y, Ruan Y, Lin M, Dai Z, Zhang Y, Yang S, Xiao S, Chen B. Prognostic nutritional index and serum lactate dehydrogenase predict the prognosis of nasopharyngeal carcinoma patients who received intensity-modulated radiation therapy. J Cancer Res Clin Oncol 2023; 149:17795-17805. [PMID: 37934254 DOI: 10.1007/s00432-023-05485-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE This research aimed to evaluate the prognostic significance of baseline prognostic nutritional index (PNI) and lactate dehydrogenase (LDH) for the outcome of individuals diagnosed with non-metastatic nasopharyngeal carcinoma (NPC). METHODS A retrospective analysis was conducted on data from 810 patients with non-metastatic NPC who underwent intensity-modulated radiation therapy (IMRT) with or without chemotherapy. The best cut-offs for PNI and LDH were identified by X-tile software to be 48.5 and 150, respectively. To find the independent prognostic factors for survival outcomes, univariate and multivariate regression analyses were conducted, and AUCs were used to compare their prognostic values. RESULTS Multivariate analysis revealed that patients with PNI > 48.5 had better overall survival (OS) (HR: 0.502, P < 0.001), progression-free survival (PFS) (HR: 0.618, P < 0.001), and distant metastasis-free survival (DMFS) (HR: 0.637, P = 0.005). Higher LDH was associated with poorer OS (HR: 1.798, P < 0.001), PFS (HR: 1.671, P < 0.001), and DMFS (HR: 1.756, P < 0.001). The combination of low PNI and high LDH in non-metastatic NPC patients was correlated with poor OS (P < 0.001), PFS (P < 0.001), and DMFS (P < 0.001). The combination of PNI and LDH had the highest AUCs for predicting OS, PFS, and DMFS. CONCLUSIONS PNI and LDH might become valuable predictors of the prognosis of non-metastatic NPC patients undergoing IMRT with or without chemotherapy. Prognostic accuracy can be enhanced by combining PNI and LDH.
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Affiliation(s)
- Chunxia Zhang
- Department of Critical Care Medicine, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, No. 420 Fuma Road, Fuzhou, 350014, China
| | - Zhouwei Zhan
- Department of Medical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Yunxiang Fang
- Clinical Oncology School, Fujian Medical University, Fujian, China
| | - Yuanyuan Ruan
- Clinical Oncology School, Fujian Medical University, Fujian, China
| | - Mingan Lin
- Clinical Oncology School, Fujian Medical University, Fujian, China
| | - Zhisen Dai
- Department of Anesthesiology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Yanping Zhang
- Department of Anesthesiology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Shanshan Yang
- Clinical Oncology School, Fujian Medical University, Fujian, China
| | - Shuxiang Xiao
- Clinical Oncology School, Fujian Medical University, Fujian, China
| | - Bijuan Chen
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China.
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Temilola DO, Adeola HA, Grobbelaar J, Chetty M. Liquid Biopsy in Head and Neck Cancer: Its Present State and Future Role in Africa. Cells 2023; 12:2663. [PMID: 37998398 PMCID: PMC10670726 DOI: 10.3390/cells12222663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/12/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023] Open
Abstract
The rising mortality and morbidity rate of head and neck cancer (HNC) in Africa has been attributed to factors such as the poor state of health infrastructures, genetics, and late presentation resulting in the delayed diagnosis of these tumors. If well harnessed, emerging molecular and omics diagnostic technologies such as liquid biopsy can potentially play a major role in optimizing the management of HNC in Africa. However, to successfully apply liquid biopsy technology in the management of HNC in Africa, factors such as genetic, socioeconomic, environmental, and cultural acceptability of the technology must be given due consideration. This review outlines the role of circulating molecules such as tumor cells, tumor DNA, tumor RNA, proteins, and exosomes, in liquid biopsy technology for the management of HNC with a focus on studies conducted in Africa. The present state and the potential opportunities for the future use of liquid biopsy technology in the effective management of HNC in resource-limited settings such as Africa is further discussed.
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Affiliation(s)
- Dada Oluwaseyi Temilola
- Department of Craniofacial Biology, Faculty of Dentistry, University of the Western Cape, Tygerberg Hospital, Cape Town 7505, South Africa;
| | - Henry Ademola Adeola
- Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, University of the Western Cape, Tygerberg Hospital, Cape Town 7505, South Africa;
- Division of Dermatology, Department of Medicine, Faculty of Health Sciences and Groote Schuur Hospital, University of Cape Town, Cape Town 7925, South Africa
| | - Johan Grobbelaar
- Division of Otorhinolaryngology, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town 7505, South Africa;
| | - Manogari Chetty
- Department of Craniofacial Biology, Faculty of Dentistry, University of the Western Cape, Tygerberg Hospital, Cape Town 7505, South Africa;
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Huang R, Chen K, Jiang Y, Li L, Zhu X. Development of Prognostic Nomogram Based on Lipid Metabolic Markers and Lactate Dehydrogenase in Non-Metastatic Nasopharyngeal Carcinoma. J Inflamm Res 2023; 16:3093-3107. [PMID: 37520664 PMCID: PMC10378618 DOI: 10.2147/jir.s416801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/11/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose To establish and verify a comprehensive prognostic nomogram for predicting survival outcomes and improving the prognosis for non-metastatic nasopharyngeal carcinoma (NPC). Patients and Methods Our retrospective study screened 613 cases of non-metastatic NPC who received radiotherapy from July 2012 to December 2016. A reliable nomogram was formulated for predicting overall survival (OS) and progression-free survival (PFS) using all independent predictors selected by Cox regression analysis. A comparison is conducted between the current staging and the predictive performance of the nomogram. Internal validation was performed in a single center using the validation cohort to assess predictive accuracy and discrimination. Results High-density lipoprotein cholesterol, Epstein-Barr virus DNA and lactate dehydrogenase were determined to be valuable predictive indicators for predicting OS and PFS. Triglycerides were a valuable predictive indicator for predicting OS. Calibration curves demonstrated that the nomogram had remarkable correspondence between the prediction outcomes and the actual observations. Receiver operating characteristic curves showed that the nomogram had greater area under the curve and more satisfactory discrimination capability than the current TNM staging. Decision curve analysis revealed that the nomogram had high net clinical benefits. Significant differences were observed when low- and high-risk groups were stratified via Kaplan-Meier curves. Conclusion Our proposed nomogram combining lipid metabolic markers and lactate dehydrogenase could assist clinicians in the accurate prognostic prediction of non-metastatic NPC patients and provide personalized treatment recommendations.
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Affiliation(s)
- Rong Huang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, People’s Republic of China
| | - Kaihua Chen
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, People’s Republic of China
| | - Yuting Jiang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, People’s Republic of China
| | - Ling Li
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, People’s Republic of China
| | - Xiaodong Zhu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, People’s Republic of China
- Department of Oncology, Affiliated Wu-Ming Hospital of Guangxi Medical University, Nanning, People’s Republic of China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education/Guangxi Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Nanning, People’s Republic of China
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