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Original Article | Open Access

Epstein-Barr virus DNA loads in the peripheral blood cells predict the survival of locoregionally-advanced nasopharyngeal carcinoma patients

Yongqiao He1,2,*, Dawei Yang2,3,*, Ting Zhou2, Wenqiong Xue2, Jiangbo Zhang2, Fangfang Li2,4, Fang Wang1,2, Tongmin Wang2, Ziyi Wu2, Ying Liao2, Meiqi Zheng2,3, Changmi Deng2, Danhua Li2, Yijing Jia2,3, Leilei Yuan2,3, Wenli Zhang2, Weihua Jia1,2,3 ( )
Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510030, China
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510030, China
School of Public Health, Sun Yat-sen University, Guangzhou 510030, China
Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510030, China

*These authors contributed equally to this work.

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Abstract

Objective

Circulating cell-free Epstein-Barr virus (EBV) DNA has been shown to be a valuable biomarker for population screening and prognostic surveillance for nasopharyngeal carcinoma (NPC). Despite important insights into the biology of persistence, few studies have addressed the clinical significance of cell-based EBV-DNA loads in peripheral blood cells (PBCs).

Methods

A prospective observational cohort study was conducted involving 1,063 newly diagnosed, locoregionally-advanced NPC patients at Sun Yat-sen University Cancer Center from 2005 to 2007. Cox regression analysis was conducted to identify the association of PBC EBV DNA loads to overall survival (OS) and other prognostic outcomes. Prognostic nomograms were developed based on PBC EBV DNA loads to predict survival outcomes for NPC patients.

Results

After a median follow-up of 108 months, patients with higher PBC EBV-DNA loads had significantly worse OS [hazard ratio (HR) of medium, medium-high, and high vs. low were 1.50, 1.52, and 1.85 respectively; Ptrend＜0.001]. Similar results were found for progression-free survival and distant metastasis-free survival. The concordance index of the prognostic nomogram for predicting OS in the training set and validation set were 0.70 and 0.66, respectively. Our data showed that the PBC EBV DNA load was an independent and robust survival biomarker, which remained significant even after adjusting for plasma EBV DNA loads in a subset of 205 patients of the cohort (HR: 1.88; P = 0.025). Importantly, a combination of PBC EBV DNA load and plasma EBV DNA load improved the predicted OS.

Conclusions

The EBV-DNA load in PBCs may be an independent prognosis marker for NPC patients.

Keywords

prognosisnomogramNasopharyngeal carcinomaEpstein-Barr virus DNAperipheral blood cells

Electronic Supplementary Material

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Cancer Biology & Medicine
Volume 18 Issue 3,
August 2021
Pages 888-899
DOI: 10.20892/j.issn.2095-3941.2020.0464
Cite this article:
He Y, Yang D, Zhou T, et al. Epstein-Barr virus DNA loads in the peripheral blood cells predict the survival of locoregionally-advanced nasopharyngeal carcinoma patients. Cancer Biology & Medicine, 2021, 18(3): 888-899. https://doi.org/10.20892/j.issn.2095-3941.2020.0464

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Received: 11 August 2020
Accepted: 09 December 2020
Published: 01 August 2021
©2021 Cancer Biology & Medicine.

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