EB病毒DNA與鼻咽癌治療預(yù)后之相關(guān)聯(lián)性

TherelationshipbetweenEBVDNAandprognosisinnasopharyngealcarcinoma蘇彥燁

Outline?Introductionofnasopharynx?Introductionofnasopharyngealcarcinoma(NPC)?RelatedarticlesofEBVDNAandNPCprognosis?-EBVDNAlevelandNPCrecurrence?-EBVDNAlevelanddistantmetastasis?-EBVDNAlevelandsurvival?Thenasopharynx(nasalpartofthepharynx)istheuppermostpartofthepharynx?ItextendsfromthebaseoftheskulltotheuppersurfaceofthesoftpalateNasopharynxFossaofRosenmullerNasopharynxExaminationofNasopharynxNasopharyngoscopeFossaofRosenmuller

NasopharyngealCarcinoma(NPC)?Epidemiology---?CommoninsouthernregionsofChina,particularlyinGuangdong,Fujian,Hong-kongandTaiwan?150casesper100,000peopleinGuangdong,7.7casesper100,000peopleinTaiwan,and0.1~1.7per100,000peopleinUSA?NPCisseenprimarilyinmiddle-?Etiology---?Cause??Notclear?EBvirus-relatedtoundifferentiatedtype?Gene-(HLA-A2,Aw19,BSin2,B17,BW16)?Diet(saltedvegetables,fishandmeat-dimethylnitrosamines)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?ThefailureofcompleteandrapideliminationofEBVDNAfromthecirculationpredicts?ThisstudyprovideconvincingevidencefortheuseofplasmaEBVDNAmeasurementsfortheearlydiagnosisandstagingofNPCawellasformonitoringrecurrenceandmetastasisofthistumor?ShaoJY.etal.Cancer.2004?TheusefulnessofEBVDNAasausefultoolinmonitoringNPCbyitsabilitytodetectearlyrecurrenceandexcellentcorrelationwithtreatmentresponse?ChanSLetal.BMCCancer.2006?TheplasmaEBVDNAassaycorrectlypredictedEBVDNAlevelandNPCrecurrence?Therisksofloco-regionalfailurewerenotsignificantlydifferentbetweenpatientswithhighandthosewithlowEBVDNAlevels?LeungSF.etal.Cancer.2003?PlasmaEBVDNAloadmeasurementappearstobeusefulinalowtumorriskarea(westernEurope).However,developmentoflocalrecurrencesmaynotalwayscoincidewithraisedlevelofEBVDNA?KalpoeJS.etal.JClinPathol.2006

EBVDNAlevelandNPCrecurrenceConclusion---NPCrecurrencewashighlyrelatedtoEBVDNAlevel,butnotalwayscoincidedWithanasymptomaticriseintheplasmaEBVDNAlevel,tumorrecurrenceshouldbeconsideredEBVDNAlevelandNPCrecurrenceEBVDNAlevelanddistantmetastasisEBVDNAlevelanddistantmetastasis?Patientswithdistantfailurehadsignificantlyhigherpre-therapyEBVDNAlevelsthanthosewithoutfailureLeungSF.etal.Cancer2003

KaplanMeierplotoffreedomfromdistantfailureforpatientsubgroupswithhighversuslowpretherapyEpsteinBarrvirus(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.2006

EBVDNAlevelandsurvival?SurvivalprobabilitiesofpatientgroupsaccordingtoEpstein-Barrvirus(EBV)DNAlevels.LowDNAdenoteslowEBVDNAlevelsoflessthan4000copies/ml,andhighDNAdenoteshighEBVDNAlevelsof4000copies/ml?EBVDNAstatusremainsastrongpredictorforoverallsurvivalinNPC?KennethWY.etal.ClinCancerRes.2006?Metastatic/recurrentNPCpatientswithlowpre-treatmentplasmaEBVDNAlevelandundetectablepost-treatmentplasmaEBVDNAshowedafavorableprognosisandsurvival?AnX.etal.Cancer.2011

EBVDNAlevelandsurvival?The5-yearoverallsurvivalrateinlowpre-treatmentplasmaEBVDNAlevelandundetectablepost-treatmentplasmaEBVDNAsubgroupwas50.6%.However,nopatientsintheother3subgroupssurvived5yearsConclusion---EBVDNAlevelwashighlyrelatedtosurvivalrateLowerpre-treatmentplasmaEBVDNAlevelandundetectablepost-treatmentplasmaEBVDNAshowedthebestprognosisEBVDNAlevelandsurvivalEBVDNAlevelandtreatmentresponseEBVDNAlevelandtreatmentresponse?RapidclearanceofplasmaEpstein-BarrvirusDNAaftersurgicaltreatmentofnasopharyngealcarcinoma?ToEW.etal.ClinCanerRes.2003

?TheinvivoeliminationofEBVDNAisveryrapidaftersurgicalresectionofNPC?PlasmaEBVDNAclearancerateasanovelprognosticmarkerformetastatic/recurrentnasopharyngealcarcinoma?WangWY.etal.ClinCancerRes.2010

?Patientswithashortt1/2ofplasmaEBVDNAclearancehavesignificantlyhighercompleteresponserateandoverallEBVDNAlevelandtreatmentresponse?TheplasmaEBVDNAconcentrationshavenosignificanteffectsonoutcomeprediction?Thet1/2ofplasmaEBVDNAclearanceshowssignificanteffectsontumorresponse?Theclearanceratesofpla