EB病毒DNA與鼻咽癌治療預后之有關聯性

TherelationshipbetweenEBVDNAandprognosisinnasopharyngealcarcinoma蘇彥燁OutlineIntroductionofnasopharynxIntroductionofnasopharyngealcarcinoma(NPC)RelatedarticlesofEBVDNAandNPCprognosis-EBVDNAlevelandNPCrecurrence-EBVDNAlevelanddistantmetastasis-EBVDNAlevelandsurvival-EBVDNAlevelandtreatmentresponseThenasopharynx(nasalpartofthepharynx)istheuppermostpartofthepharynxItextendsfromthebaseoftheskulltotheuppersurfaceofthesoftpalateNasopharynxFossaofRosenmullerNasopharynxExaminationofNasopharynxNasopharyngoscopeFossaofRosenmullerNasopharyngealCarcinoma(NPC)Epidemiology---CommoninsouthernregionsofChina,particularlyinGuangdong,Fujian,Hong-kongandTaiwan150casesper100,000peopleinGuangdong,7.7casesper100,000peopleinTaiwan,and0.1~1.7per100,000peopleinUSANPCisseenprimarilyinmiddle-aged(45~55y/o)personsinAsia,ahighproportionofAfricancasesappearinchildrenEtiology---Cause??NotclearEBvirus-relatedtoundifferentiatedtypeGene-(HLA-A2,Aw19,BSin2,B17,BW16)Diet(saltedvegetables,fishandmeat-dimethylnitrosamines)Environmentsmoking,nickelexposure,formaldehyde(甲醛)NasopharyngealCarcinoma(NPC)NPCNormalSymptomsandSignsNeckmassEarfullnessandhearingimpairment(middleeareffusion)BloodtingledsputumNasalobstructionHeadacheDiplopiaDiagnosisandTreatmentBiopsy!!!TreatmentRadiotherapy+/-chemotherapyOperation(salvage)RelatedArticlesof

EBVDNAandNPCprognosisEBVDNAlevelandNPCrecurrenceEBVDNAlevelandNPCrecurrencePlasma/serumcell-freeEBVDNAmaybeavaluabletoolforthemonitorofNPCpatientsfortheearlydetectionoftumorrecurrenceLoYM.etal.CancerRes.1999CirculatingEBVDNAhasbeenfoundnotonlytocorrelatewithdiseasestaging,butalsotoprovideusefulinformationforthemonitoringfortumorrecurrenceLoYM.etal.BiomedPharmacother.2023.ReviewThefailureofcompleteandrapideliminationofEBVDNAfromthecirculationpredictsdiseaserecurrenceToEW.etal.ClinCancerRes.2023ThisstudyprovideconvincingevidencefortheuseofplasmaEBVDNAmeasurementsfortheearlydiagnosisandstagingofNPCawellasformonitoringrecurrenceandmetastasisofthistumorShaoJY.etal.Cancer.2023TheusefulnessofEBVDNAasausefultoolinmonitoringNPCbyitsabilitytodetectearlyrecurrenceandexcellentcorrelationwithtreatmentresponseChanSLetal.BMCCancer.2023TheplasmaEBVDNAassaycorrectlypredictedallNPCrecurrences,andPEThadhighcapacitytolocalizepotentiallesionsitesWangWYetal.Cancer.2023EBVDNAlevelandNPCrecurrenceTherisksofloco-regionalfailurewerenotsignificantlydifferentbetweenpatientswithhighandthosewithlowEBVDNAlevelsLeungSF.etal.Cancer.2023PlasmaEBVDNAloadmeasurementappearstobeusefulinalowtumorriskarea(westernEurope).However,developmentoflocalrecurrencesmaynotalwayscoincidewithraisedlevelofEBVDNAKalpoeJS.etal.JClinPathol.2023EBVDNAlevelandNPCrecurrenceConclusion---NPCrecurrencewashighlyrelatedtoEBVDNAlevel,butnotalwayscoincidedWithanasymptomaticriseintheplasmaEBVDNAlevel,tumorrecurrenceshouldbeconsideredEBVDNAlevelandNPCrecurrenceEBVDNAlevelanddistantmetastasisEBVDNAlevelanddistantmetastasisPatientswithdistantfailurehadsignificantlyhigherpre-therapyEBVDNAlevelsthanthosewithoutfailureLeungSF.etal.Cancer2023KaplanMeierplotoffreedomfromdistantfailureforpatientsubgroupswithhighversuslowpretherapyEpsteinBarrvirus(EBV)DNAlevelsThetimetothefirstdetectionofcirculatingEBVDNAwassignificantlyshorteramongpatientswithdistantmetastasis.MonitoringplasmaEBVDNAlevelsurpassedtraditionalmethodsfortheearlydetectionofdistantfailureinpatientswithNPCHongRL.etal.Cancer.2023TheuseofplasmaEBVDNAmeasurementsfortheearlydiagnosisandstagingofNPCawellasformonitoringrecurrenceandmetastasisofthistumorShaoJY.etal.Cancer2023EBVDNAlevelanddistantmetastasisConclusion---EBVDNAlevelwashighlyrelatedtodistantmetastasisClosemonitoringEBVDNAlevelcouldearlydetectdistantfailureinNPCpatientsEBVDNAlevelanddistantmetastasisEBVDNAlevelandsurvivalLevelsofpost-treatmentplasmaEBVDNAinpatientswithNPCappeartostronglypredictprogression-freeandoverallsurvivalandtoaccuratelyreflectthepost-treatmentresidualtumorloadChanAT.etal.JNatlCancerinst.2023Pre-therapycirculatingEBVDNAloadisanindependentprognosticfactorforoverallsurvivalinNPCLeungSF.etal.JClinOncol.2023EBVDNAlevelandsurvivalSurvivalprobabilitiesofpatientgroupsaccordingtoEpstein-Barrvirus(EBV)DNAlevels.LowDNAdenoteslowEBVDNAlevelsoflessthan4000copies/ml,andhighDNAdenoteshighEBVDNAlevelsof4000copies/mlLeungSF.etal.JClinOncol.2023EBVDNAstatusremainsastrongpredictorforoverallsurvivalinNPCKennethWY.etal.ClinCancerRes.2023Metastatic/recurrentNPCpatientswithlowpre-treatmentplasmaEBVDNAlevelandundetectablepost-treatmentplasmaEBVDNAshowedafavorableprognosisandsurvivalAnX.etal.Cancer.2023EBVDNAlevelandsurvivalThe5-yearoverallsurvivalrateinlowpre-treatmentplasmaEBVDNAlevelandundetectablepost-treatmentplasmaEBVDNAsubgroupwas50.6%.However,nopatientsintheother3subgroupssurvived5yearsAnX.etal.Cancer.2023Conclusion---EBVDNAlevelwashighlyrelatedtosurvivalrateLowerpre-treatmentplasmaEBVDNAlevelandundetectablepost-treatmentplasmaEBVDNAshowedthebestprognosisEBVDNAlevelandsurvivalEBVDNAlevelandtreatmentresponseEBVDNAlevelandtreatmentresponseRapidclearanceofplasmaEpstein-BarrvirusDNAaftersurgicaltreatmentofnasopharyngealcarcinomaToEW.etal.ClinCanerRes.2023TheinvivoeliminationofEBVDNAisveryrapidaftersurgicalresectionofNPCThefailureofcompleteandrapideliminationofEBVDNAfromthecirculationpredictsdiseaserecurrencePlasmaEBVDNAclearancerateasanovelprognosticmarkerformetastatic/recurrentnasopharyngealcarcinomaWangWY.etal.ClinCancerRes.2023Patientswithashortt1/2ofplasmaEBVDNAclearancehavesignificantlyhighercompleteresponserateandoverallsurvivalthanthosewithlongt1/2TheplasmaEBVDNAconcentrationshavenosignificanteffectsonoutcomepredictionEBVDNAlevelandtreatmentresponseTheplasmaEBVDNAconcentrationshavenosignificanteffectsonoutcomepredictionThet1/2ofplasmaEBVDNAclearanceshows