Combining plasma Epstein-Barr virus DNA and nodal maximal standard uptake values of 18F-fluoro-2-deoxy-D-glucose positron emission tomography improved prognostic stratification to predict distant metastasis for locoregionally advanced nasopharyngeal carcinoma

Wen-Hui Chen, Lin-Quan Tang, Lu Zhang, Qiu-Yan Chen, Shan-Shan Guo, Li-Ting Liu, Wei Fan, Xu Zhang, Ling Guo, Chong Zhao, Ka-Jia Cao, Chao-Nan Qian, Xiang Guo, Dan Xie, Mu-Sheng Zeng, Hai-Qiang Mai
Oncotarget 2015 November 10, 6 (35): 38296-307

BACKGROUND: This study aimed to evaluate the value of combining the nodal maximal standard uptake values (SUVmax) of (18) F-fluoro-2-deoxy-D-glucose positron emission tomography with Epstein-Barr virus DNA(EBV DNA) levels to predict distant metastasis for nasopharyngeal carcinoma (NPC) patients.

PATIENTS AND METHODS: Eight hundred seventy-four patients with stage III-IVa-b NPC were evaluated for the effects of combining SUVmax and EBV DNA levels on distant metastasis-free survival (DMFS), disease-free survival (DFS) and overall survival (OS).

RESULTS: The optimal cutoff value was 6,220 copies/mL for EBV DNA and 7.5 for SUVmax-N. Patients with lower EBV DNA levels or SUVmax-N had a significantly better 3-year DMFS, DFS, and OS. Patients were divided into four groups based on EBV DNA and SUVmax-N, as follows: low EBV DNA and low SUVmax-N (LL), low EBV DNA and high SUVmax-N (LH), high EBV DNA and low SUVmax-N (HL), and high EBV DNA and high SUVmax-N (HH). There were significant differences between the four mentioned groups in 3-year DMFS: 95.7%, 92.2%, 92.3%, and 80.1%, respectively (P(trend) < 0.001). When looking at the disease stage, the 3-year DMFS in group LL, LH, HL, HH were 94.2%, 92.9%, 95.0%, and 81.1%, respectively, in stage III patients (P(trend) < 0.001) and 92.7%, 87.2%, 86.3%, and 77.0% in stage IVa-b patients (P(trend) = 0.026).

CONCLUSION: Pretreatment EBV DNA and SUVmax of neck lymph nodes were independent prognostic factors for distant metastasis in NPC patients. Combining EBV DNA and SUVmax-N led to an improved risk stratification for distant metastasis in advanced-stage disease.

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