Development of a risk classification system combining TN-categories and circulating EBV DNA for non-metastatic NPC in 10,149 endemic cases

Background: The objective of this study was to construct a risk classification system integrating cell-free Epstein-Barr virus (cfEBV) DNA with T- and N- categories for better prognostication in nasopharyngeal carcinoma (NPC). Methods: Clinical records of 10,149 biopsy-proven, non-metastatic NPC wer...

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Published in:Therapeutic advances in medical oncology 2021, Vol.13, p.17588359211052417-17588359211052417
Main Authors: Chen, Fo-Ping, Lin, Li, Liang, Jin-Hui, Tan, Sze Huey, Ong, Enya H.W., Luo, Ying-Shan, Huang, Luo, Sim, Adelene Y.L., Wang, Hai-Tao, Gao, Tian-Sheng, Deng, Bin, Zhou, Guan-Qun, Kou, Jia, Chua, Melvin L.K., Sun, Ying
Format: Article
Language:English
Subjects:
Biopsy
Cancer
Classification
Deoxyribonucleic acid
DNA
DNA viruses
Epstein-Barr virus
Metastases
Metastasis
Nasopharyngeal carcinoma
Original Research
Risk groups
Throat cancer
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Summary:Background: The objective of this study was to construct a risk classification system integrating cell-free Epstein-Barr virus (cfEBV) DNA with T- and N- categories for better prognostication in nasopharyngeal carcinoma (NPC). Methods: Clinical records of 10,149 biopsy-proven, non-metastatic NPC were identified from two cancer centers; this comprised a training (N = 9,259) and two validation cohorts (N = 890; including one randomized controlled phase 3 trial cohort). Adjusted hazard ratio (AHR) method using a two-tiered stratification by cfEBV DNA and TN-categories was applied to generate the risk model. Primary clinical endpoint was overall survival (OS). Performances of the models were compared against American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) 8th edition TNM-stage classification and two published recursive partitioning analysis (RPA) models, and were validated in the validation cohorts. Results: We chose a cfEBV DNA cutoff of ⩾2,000 copies for optimal risk discretization of OS, disease-free survival (DFS) and distant metastasis-free survival (DMFS) in the training cohort. AHR modeling method divided NPC into six risk groups with significantly disparate survival (p  
ISSN:1758-8359
1758-8340
1758-8359
DOI:10.1177/17588359211052417