EB病毒DNA与鼻咽癌治疗预后之相关联性

EB病毒DNA与鼻咽癌治疗预后之相关联性TherelationshipbetweenEBVDNAandprognosisinnasopharyngealcarcinoma苏彦烨Outline•Introductionofnasopharynx•Introductionofnasopharyngealcarcinoma(NPC)•RelatedarticlesofEBVDNAandNPCprognosis•-EBVDNAlevelandNPCrecurrence•-EBVDNAlevelanddistantmetastasis•-EBVDNAlevelandsurvival•-EBVDNAlevelandtreatmentresponse•Thenasopharynx(nasalpartofthepharynx)istheuppermostpartofthepharynx•ItextendsfromthebaseoftheskulltotheuppersurfaceofthesoftpalateNasopharynxFossaofRosenmullerNasopharynxExaminationofNasopharynxNasopharyngoscopeFossaofRosenmullerNasopharyngealCarcinoma(NPC)•Epidemiology---•CommoninsouthernregionsofChina,particularlyinGuangdong,Fujian,Hong-kongandTaiwan•150casesper100,000peopleinGuangdong,7.7casesper100,000peopleinTaiwan,and0.1~1.7per100,000peopleinUSA•NPCisseenprimarilyinmiddle-aged(45~55y/o)personsinAsia,ahighproportionofAfricancasesappearinchildren•Etiology---•Cause??Notclear•EBvirus-relatedtoundifferentiatedtype•Gene-(HLA-A2,Aw19,BSin2,B17,BW16)•Diet(saltedvegetables,fishandmeat-dimethylnitrosamines)•Environmentsmoking,nickelexposure,formaldehyde(甲醛)NasopharyngealCarcinoma(NPC)NPCNormalSymptomsandSigns•Neckmass•Earfullnessandhearingimpairment•(middleeareffusion)•Bloodtingledsputum•Nasalobstruction•Headache•DiplopiaDiagnosisandTreatment•Biopsy!!!•Treatment•Radiotherapy+/-chemotherapy•Operation(salvage)RelatedArticlesofEBVDNAandNPCprognosisEBVDNAlevelandNPCrecurrenceEBVDNAlevelandNPCrecurrence•Plasma/serumcell-freeEBVDNAmaybeavaluabletoolforthemonitorofNPCpatientsfortheearlydetectionoftumorrecurrence•LoYM.etal.CancerRes.1999•CirculatingEBVDNAhasbeenfoundnotonlytocorrelatewithdiseasestaging,butalsotoprovideusefulinformationforthemonitoringfortumorrecurrence•LoYM.etal.BiomedPharmacother.2001.Review•ThefailureofcompleteandrapideliminationofEBVDNAfromthecirculationpredictsdiseaserecurrence•ToEW.etal.ClinCancerRes.2003•ThisstudyprovideconvincingevidencefortheuseofplasmaEBVDNAmeasurementsfortheearlydiagnosisandstagingofNPCawellasformonitoringrecurrenceandmetastasisofthistumor•ShaoJY.etal.Cancer.2004•TheusefulnessofEBVDNAasausefultoolinmonitoringNPCbyitsabilitytodetectearlyrecurrenceandexcellentcorrelationwithtreatmentresponse•ChanSLetal.BMCCancer.2006•TheplasmaEBVDNAassaycorrectlypredictedallNPCrecurrences,andPEThadhighcapacitytolocalizepotentiallesionsites•WangWYetal.Cancer.2011EBVDNAlevelandNPCrecurrence•Therisksofloco-regionalfailurewerenotsignificantlydifferentbetweenpatientswithhighandthosewithlowEBVDNAlevels•LeungSF.etal.Cancer.2003•PlasmaEBVDNAloadmeasurementappearstobeusefulinalowtumorriskarea(westernEurope).However,developmentoflocalrecurrencesmaynotalwayscoincidewithraisedlevelofEBVDNA•KalpoeJS.etal.JClinPathol.2006EBVDNAlevelandNPCrecurrenceConclusion---NPCrecurrencewashighlyrelatedtoEBVDNAlevel,butnotalwayscoincidedWithanasymptomaticriseintheplasmaEBVDNAlevel,tumorrecurrenceshouldbeconsideredEBVDNAlevelandNPCrecurrenceEBVDNAlevelanddistantmetastasisEBVDNAlevelanddistantmetastasis•Patientswithdistantfailurehadsignificantlyhigherpre-therapyEBVDNAlevelsthanthosewithoutfailureLeungSF.etal.Cancer2003KaplanMeierplotoffreedomfromdistantfailureforpatientsubgroupswithhighversuslowpretherapyEpsteinBarrvirus(EBV)DNAlevels•ThetimetothefirstdetectionofcirculatingEBVDNAwassignificantlyshorteramongpatientswithdistantmetastasis.MonitoringplasmaEBVDNAlevelsurpassedtraditionalmethodsfortheearlydetectionofdistantfailureinpatientswithNPC•HongRL.etal.Cancer.2004•TheuseofplasmaEBVDNAmeasurementsfortheearlydiagnosisandstagingofNPCawellasformonitoringrecurrenceandmetastasisofthistumor•ShaoJY.etal.Cancer2004EBVDNAlevelanddistantmetastasisConclusion---EBVDNAlevelwashighlyrelatedtodistantmetastasisClosemonitoringEBVDNAlevelcouldearlydetectdistantfailureinNPCpatientsEBVDNAlevelanddistantmetastasisEBVDNAlevelandsurvival•Levelsofpost-treatmentplasmaEBVDNAinpatientswithNPCappeartostronglypredictprogression-freeandoverallsurvivalandtoaccuratelyreflectthepost-treatmentresidualtumorload•ChanAT.etal.JNatlCancerinst.2002•Pre-therapycirculatingEBVDNAloadisanindependentprognosticfactorforoverallsurvivalinNPC•LeungSF.etal.JClinOncol.2006EBVDNAlevelandsurvival•SurvivalprobabilitiesofpatientgroupsaccordingtoEpstein-Barrvirus(EBV)DNAlevels.LowDNAdenoteslowEBVDNAlevelsoflessthan4000copies/ml,andhighDNAdenoteshighEBVDNAlevelsof4000copies/ml•LeungSF.etal.JClinOncol.2006•EBVDNAstatusremainsastrongpredictorforoverallsurvivalinNPC•KennethWY.etal.ClinCancerRes.2006•Metastatic/recurrentNPCpatientswithlowpre-treatmentplasmaEBVDNAlevelandundetectablepost-treatmentplasmaEBVDNAshowedafavorableprognosisandsurvival•AnX.etal.Cancer.2011EBVDNAlevelandsurvival•The5-yearoverallsurvivalrateinlowpre-treatmentplasmaEBVDNAlevelandundetectablepost-treatmentplasmaEBVDNAsubgroupwas50.6%.However,nopatientsintheother3subgroupssurvived5years•AnX.etal.Cancer.2011Conclusion---EBVDNAlevelwashighlyrelatedtosurvivalrateLowerpre-treatmentplasmaEBVDNAlevelandundetectablepost-treatmentplasmaEBVDNAshowedthebestprognosisEBVDNAlevelandsurvivalEBVDNAlevelandtreatm