Spontaneous remission of residual post‐therapy plasma Epstein–Barr virus DNA and its prognostic implication in nasopharyngeal carcinoma: A large‐scale, big‐data intelligence platform‐based analysis

• Published in: International journal of cancer 2019-05, Vol.144 (9), p.2313-2319
• Main Authors: Zhang, Yuan, Tang, Ling‐long, Li, Ying‐Qin, Liu, Xu, Liu, Qing, Ma, Jun
• Format: Article
• Language: English
• Subjects: Cancer; Data processing; Deoxyribonucleic acid; DNA; Epstein-Barr virus; Health risks; Intelligence; Medical prognosis; Medical research; Metastases; Multivariate analysis; Nasopharyngeal carcinoma; Plasma; post‐therapy; prognosis; Remission; residual plasma EBV DNA; Risk assessment; spontaneous remission; Survival; Throat cancer
• ISSN: 0020-7136; 1097-0215
• DOI: 10.1002/ijc.32021

Detectable post‐therapy plasma Epstein–Barr virus (EBV) DNA predicts poor survival in non‐metastatic nasopharyngeal carcinoma (NPC). However, some patients subsequently experience spontaneous remission of residual EBV DNA during follow‐up and it was unclear whether these patients were still at high risk of disease failure. Using the NPC database from an established big‐data intelligence platform, 3269 NPC patients who had the plasma EBV DNA load measured at the end of therapy (± 1 week) were identified. In total, 93.0% (3031/3269) and 7.0% (238/3269) of patients had undetectable and detectable (> 0 copy/ml) plasma EBV DNA at the end of therapy (EBV DNAend), respectively. Detectable EBV DNAend was a prognostic factor for poorer 3‐year disease‐free survival (DFS), overall survival (OS), distant metastasis‐free survival (DMFS), and loco‐regional recurrence‐free survival (LRRFS) in both univariate and multivariate analyses. Of 238 patients with residual EBV DNAend, 192 underwent EBV DNA assay 3 months after and spontaneous remission occurred in 72.4% (139/192). However, these patients still had poorer 3‐year DFS (55.1% vs. 89.8%), OS (79.1% vs. 96.2%), DMFS (68.4% vs. 94.1%) and LRRFS (84.5% vs. 95.0%) than patients with undetectable EBV DNAend (all p < 0.001). And patients with persistent detectable post‐therapy EBV DNA had the worst outcomes. These results were confirmed in multivariate analysis. In conclusion, residual EBV DNA post therapy was a robust biomarker for NPC prognosis. Although residual post‐therapy EBV DNA could spontaneous remit during follow‐up, these patients were still at high risk of disease failure and such patients may benefit from adjuvant therapy. What's new? Maintenance of circulating Epstein‐Barr virus (EBV) DNA after treatment is associated with poor disease outcome in patients with nasopharyngeal carcinoma. Here the authors focused on the small percentage of patients who initially maintain EBV DNA after therapy but eventually clear this marker from their blood. These patients maintain a high risk of disease failure when compared to patients with no detectable post‐therapy EBV DNA, underscoring the prognostic value of nuanced EBV DNA measurements after nasopharyngeal cancer treatment.