1、EB病毒 DNA与鼻咽癌治疗预后之相关联性 The relationship between EBV DNA and prognosis in nasopharyngeal carcinoma 苏彦烨 Outline?Introduction of nasopharynx?Introduction of nasopharyngeal carcinoma(NPC)?Related articles of EBV DNA and NPC prognosis?-EBV DNA level and NPC recurrence?-EBV DNA level and distant metastasis
2、?-EBV DNA level and survival?The nasopharynx(nasal part of the pharynx)is the uppermost part of the pharynx?It extends from the base of the skull to the upper surface of the soft palate Nasopharynx Fossa of Rosenmuller Fossa of Rosenmuller Nasopharynx Examination of Nasopharynx Nasopharyngoscope Fos
3、sa of Rosenmuller Nasopharyngeal Carcinoma(NPC)?Epidemiology-?Common in southern regions of China,particularly in Guangdong,Fujian,Hong-kong and Taiwan?150 cases per 100,000 people in Guangdong,7.7 cases per 100,000 people in Taiwan,and 0.11.7 per 100,000 people in USA?NPC is seen primarily in middl
4、e-?Etiology-?Cause?Not clear?EB virus-related to undifferentiated type?Gene-(HLA-A2,Aw19,BSin 2,B17,BW16)?Diet (salted vegetables,fish and meat-dimethylnitrosamines)Nasopharyngeal Carcinoma(NPC)NPC Normal Symptoms and Signs?Neck mass?Ear fullness and hearing impairment?(middle ear effusion)?Blood ti
5、ngled sputum?Nasal obstruction?Headache?Diplopia Diagnosis and Treatment?Biopsy!?Treatment?Radiotherapy+/-chemotherapy?Operation(salvage)Related Articles of Related Articles of EBV DNA and NPC prognosis EBV DNA and NPC prognosis EBV DNA level and NPC recurrence EBV DNA level and NPC recurrence?Plasm
6、a/serum cell-free EBV DNA may be a valuable tool for the monitor of NPC patients for the early detection of tumor recurrence?Lo YM.et al.Cancer Res.1999?Circulating EBV DNA has been found not only to correlate with disease staging,but also to provide useful information for the monitoring for tumor r
7、ecurrence?Lo YM.et al.Biomed Pharmacother.2001.Review?The failure of complete and rapid elimination of EBV DNA from the circulation predicts?This study provide convincing evidence for the use of plasma EBV DNA measurements for the early diagnosis and staging of NPC a well as for monitoring recurrenc
8、e and metastasis of this tumor?Shao JY.et al.Cancer.2004?The usefulness of EBV DNA as a useful tool in monitoring NPC by its ability to detect early recurrence and excellent correlation with treatment response?Chan SL et al.BMC Cancer.2006?The plasma EBV DNA assay correctly predicted EBV DNA level a
9、nd NPC recurrence?The risks of loco-regional failure were not significantly different between patients with high and those with low EBV DNA levels?Leung SF.et al.Cancer.2003?Plasma EBV DNA load measurement appears to be useful in a low tumor risk area(western Europe).However,development of local rec
10、urrences may not always coincide with raised level of EBV DNA?Kalpoe JS.et al.J Clin Pathol.2006 EBV DNA level and NPC recurrence Conclusion-NPC recurrence was highly related to EBV DNA level,but not always coincided With an asymptomatic rise in the plasma EBV DNA level,tumor recurrence should be co
11、nsidered EBV DNA level and NPC recurrence EBV DNA level and distant metastasis EBV DNA level and distant metastasis?Patients with distant failure had significantly higher pre-therapy EBV DNA levels than those without failure Leung SF.et al.Cancer 2003 Kaplan Meier plot of freedom from distant failur
12、e for patient subgroups with high versus low pretherapy Epstein Barr virus(EBV)DNA levels?The time to the first detection of circulating EBV DNA was significantly shorter among patients with distant metastasis.Monitoring plasma EBV DNA level surpassed traditional methods for the early detection of d
13、istant failure in patients with NPC?Hong RL.et al.Cancer.2004?The use of plasma EBV DNA measurements for the early diagnosis and staging of NPC a well as for monitoring recurrence and metastasis of this tumor?Shao JY.et al.Cancer 2004 EBV DNA level and distant metastasis Conclusion-EBV DNA level was
14、 highly related to distant metastasis Close monitoring EBV DNA level could early detect distant failure in NPC patients EBV DNA level and distant metastasis EBV DNA level and survival?Levels of post-treatment plasma EBV DNA in patients with NPC appear to strongly predict progression-free and overall
15、 survival and to accurately reflect the post-treatment residual tumor load?Chan AT.et al.J Natl Cancer inst.2002?Pre-therapy circulating EBV DNA load is an independent prognostic factor for overall survival in NPC?Leung SF.et al.J Clin Oncol.2006 EBV DNA level and survival?Survival probabilities of
16、patient groups according to Epstein-Barr virus(EBV)DNA levels.Low DNA denotes low EBV DNA levels of less than 4000 copies/ml,and high DNA denotes high EBV DNA levels of 4000 copies/ml?EBV DNA status remains a strong predictor for overall survival in NPC?Kenneth WY.et al.Clin Cancer Res.2006?Metastat
17、ic/recurrent NPC patients with low pre-treatment plasma EBV DNA level and undetectable post-treatment plasma EBV DNA showed a favorable prognosis and survival?An X.et al.Cancer.2011 EBV DNA level and survival?The 5-year overall survival rate in low pre-treatment plasma EBV DNA level and undetectable
18、 post-treatment plasma EBV DNA subgroup was 50.6%.However,no patients in the other 3 subgroups survived 5 years Conclusion-EBV DNA level was highly related to survival rate Lower pre-treatment plasma EBV DNA level and undetectable post-treatment plasma EBV DNA showed the best prognosis EBV DNA level
19、 and survival EBV DNA level and treatment response EBV DNA level and treatment response?Rapid clearance of plasma Epstein-Barr virus DNA after surgical treatment of nasopharyngeal carcinoma?To EW.et al.Clin Caner Res.2003?The in vivo elimination of EBV DNA is very rapid after surgical resection of N
20、PC?Plasma EBV DNA clearance rate as a novel prognostic marker for metastatic/recurrent nasopharyngeal carcinoma?Wang WY.et al.Clin Cancer Res.2010?Patients with a short t1/2 of plasma EBV DNA clearance have significantly higher complete response rate and overall EBV DNA level and treatment response?
21、The plasma EBV DNA concentrations have no significant effects on outcome prediction?The t1/2 of plasma EBV DNA clearance shows significant effects on tumor response?The clearance rates of plasma EBV DNA during the first month of chemotherapy can predict tumor response and patient survival?Early chan
22、ge of chemotherapy regimen may be considered for patients with slow plasma EBV DNA clearance rate?Wang WY.et al.Clin Cancer Res.2010 EBV DNA level and treatment response Conclusion-EBV DNA level was a useful tool to monitor tumor response after therapy The clearance rates of plasma EBV DNA seemed be
23、tter than the concentration of plasma EBV DNA in predicting tumor response EBV DNA level and treatment response Conclusion?EBV DNA level was a useful tool in monitoring tumor recurrence,distant metastasis,survival and treatment response in nasopharyngeal carcinoma Thanks for Your Thanks for Your Attention!Attention!
