EB病毒DNA與鼻咽癌治療預(yù)后之有關(guān)聯(lián)性

TherelationshipbetweenEBVDNAandprognosisinnasopharyngealcarcinoma蘇彥燁第1頁OutlineIntroductionofnasopharynxIntroductionofnasopharyngealcarcinoma(NPC)RelatedarticlesofEBVDNAandNPCprognosis-EBVDNAlevelandNPCrecurrence-EBVDNAlevelanddistantmetastasis-EBVDNAlevelandsurvival-EBVDNAlevelandtreatmentresponse第2頁Thenasopharynx(nasalpartofthepharynx)istheuppermostpartofthepharynxItextendsfromthebaseoftheskulltotheuppersurfaceofthesoftpalateNasopharynx第3頁FossaofRosenmullerNasopharynx第4頁ExaminationofNasopharynx第5頁第6頁Nasopharyngoscope第7頁FossaofRosenmuller第8頁NasopharyngealCarcinoma(NPC)Epidemiology---CommoninsouthernregionsofChina,particularlyinGuangdong,Fujian,Hong-kongandTaiwan150casesper100,000peopleinGuangdong,7.7casesper100,000peopleinTaiwan,and0.1~1.7per100,000peopleinUSANPCisseenprimarilyinmiddle-aged(45~55y/o)personsinAsia,ahighproportionofAfricancasesappearinchildren第9頁Etiology---Cause??NotclearEBvirus-relatedtoundifferentiatedtypeGene-(HLA-A2,Aw19,BSin2,B17,BW16)Diet(saltedvegetables,fishandmeat-dimethylnitrosamines)Environmentsmoking,nickelexposure,formaldehyde(甲醛)NasopharyngealCarcinoma(NPC)第10頁NPCNormal第11頁SymptomsandSignsNeckmassEarfullnessandhearingimpairment(middleeareffusion)BloodtingledsputumNasalobstructionHeadacheDiplopia第12頁DiagnosisandTreatmentBiopsy!!!TreatmentRadiotherapy+/-chemotherapyOperation(salvage)第13頁RelatedArticlesof

EBVDNAandNPCprognosis第14頁EBVDNAlevelandNPCrecurrence第15頁EBVDNAlevelandNPCrecurrencePlasma/serumcell-freeEBVDNAmaybeavaluabletoolforthemonitorofNPCpatientsfortheearlydetectionoftumorrecurrenceLoYM.etal.CancerRes.1999CirculatingEBVDNAhasbeenfoundnotonlytocorrelatewithdiseasestaging,butalsotoprovideusefulinformationforthemonitoringfortumorrecurrenceLoYM.etal.BiomedPharmacother.2023.ReviewThefailureofcompleteandrapideliminationofEBVDNAfromthecirculationpredictsdiseaserecurrenceToEW.etal.ClinCancerRes.2023第16頁ThisstudyprovideconvincingevidencefortheuseofplasmaEBVDNAmeasurementsfortheearlydiagnosisandstagingofNPCawellasformonitoringrecurrenceandmetastasisofthistumorShaoJY.etal.Cancer.2023TheusefulnessofEBVDNAasausefultoolinmonitoringNPCbyitsabilitytodetectearlyrecurrenceandexcellentcorrelationwithtreatmentresponseChanSLetal.BMCCancer.2023TheplasmaEBVDNAassaycorrectlypredictedallNPCrecurrences,andPEThadhighcapacitytolocalizepotentiallesionsitesWangWYetal.Cancer.2023EBVDNAlevelandNPCrecurrence第17頁Therisksofloco-regionalfailurewerenotsignificantlydifferentbetweenpatientswithhighandthosewithlowEBVDNAlevelsLeungSF.etal.Cancer.2023PlasmaEBVDNAloadmeasurementappearstobeusefulinalowtumorriskarea(westernEurope).However,developmentoflocalrecurrencesmaynotalwayscoincidewithraisedlevelofEBVDNAKalpoeJS.etal.JClinPathol.2023EBVDNAlevelandNPCrecurrence第18頁Conclusion---NPCrecurrencewashighlyrelatedtoEBVDNAlevel,butnotalwayscoincidedWithanasymptomaticriseintheplasmaEBVDNAlevel,tumorrecurrenceshouldbeconsideredEBVDNAlevelandNPCrecurrence第19頁EBVDNAlevelanddistantmetastasis第20頁EBVDNAlevelanddistantmetastasisPatientswithdistantfailurehadsignificantlyhigherpre-therapyEBVDNAlevelsthanthosewithoutfailureLeungSF.etal.Cancer2023KaplanMeierplotoffreedomfromdistantfailureforpatientsubgroupswithhighversuslowpretherapyEpsteinBarrvirus(EBV)DNAlevels第21頁ThetimetothefirstdetectionofcirculatingEBVDNAwassignificantlyshorteramongpatientswithdistantmetastasis.MonitoringplasmaEBVDNAlevelsurpassedtraditionalmethodsfortheearlydetectionofdistantfailureinpatientswithNPCHongRL.etal.Cancer.2023TheuseofplasmaEBVDNAmeasurementsfortheearlydiagnosisandstagingofNPCawellasformonitoringrecurrenceandmetastasisofthistumorShaoJY.etal.Cancer2023EBVDNAlevelanddistantmetastasis第22頁Conclusion---EBVDNAlevelwashighlyrelatedtodistantmetastasisClosemonitoringEBVDNAlevelcouldearlydetectdistantfailureinNPCpatientsEBVDNAlevelanddistantmetastasis第23頁EBVDNAlevelandsurvival第24頁Levelsofpost-treatmentplasmaEBVDNAinpatientswithNPCappeartostronglypredictprogression-freeandoverallsurvivalandtoaccuratelyreflectthepost-treatmentresidualtumorloadChanAT.etal.JNatlCancerinst.2023Pre-therapycirculatingEBVDNAloadisanindependentprognosticfactorforoverallsurvivalinNPCLeungSF.etal.JClinOncol.2023EBVDNAlevelandsurvival第25頁SurvivalprobabilitiesofpatientgroupsaccordingtoEpstein-Barrvirus(EBV)DNAlevels.LowDNAdenoteslowEBVDNAlevelsoflessthan4000copies/ml,andhighDNAdenoteshighEBVDNAlevelsof4000copies/mlLeungSF.etal.JClinOncol.2023第26頁EBVDNAstatusremainsastrongpredictorforoverallsurvivalinNPCKennethWY.etal.ClinCancerRes.2023Metastatic/recurrentNPCpatientswithlowpre-treatmentplasmaEBVDNAlevelandundetectablepost-treatmentplasmaEBVDNAshowedafavorableprognosisandsurvivalAnX.etal.Cancer.2023EBVDNAlevelandsurvival第27頁The5-yearoverallsurvivalrateinlowpre-treatmentplasmaEBVDNAlevelandundetectablepost-treatmentplasmaEBVDNAsubgroupwas50.6%.However,nopatientsintheother3subgroupssurvived5yearsAnX.etal.Cancer.2023第28頁Conclusion---EBVDNAlevelwashighlyrelatedtosurvivalrateLowerpre-treatmentplasmaEBVDNAlevelandundetectablepost-treatmentplasmaEBVDNAshowedthebestprognosisEBVDNAlevelandsurvival第29頁EBVDNAlevelandtreatmentresponse第30頁EBVDNAlevelandtreatmentresponseRapidclearanceofplasmaEpstein-BarrvirusDNAaftersurgicaltreatmentofnasopharyngealcarcinomaToEW.etal.ClinCanerRes.2023TheinvivoeliminationofEBVDNAisveryrapidaftersurgicalresectionofNPCThefailureofcompleteandrapideliminationofEBVDNAfromthecirculationpredictsdiseaserecurrence第31頁P(yáng)lasmaEBVDNAclearancerateasanovelprognosticmarkerformetastatic/recurrentnasopharyngealcarcinomaWangWY.etal.ClinCancerRes.2023Patientswithashortt1/2ofplasmaEBVDNAclearancehavesignificantlyhighercompleteresponserateandoverallsurvivalthanthosewithlongt1/2TheplasmaEBVDNAconcentrationshavenosignificanteffectsonoutcomepredictionEBVDNAlevelandtreatmentresponse第32頁第33頁第34頁TheplasmaEBVDNAconcentrationshavenosignificanteffectsonoutcomepredictionThet1/2ofplasmaEBVDNAclearanceshowssignifi