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Can Epstein-Barr virus DNA load in nasopharyngeal brushings or whole blood predict recurrent nasopharyngeal carcinoma in a non-endemic region? A prospective nationwide study of the Dutch Head and Neck Oncology Cooperative Group

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Abstract

This study estimated the value of quantitative measurements of EBV markers in the clinical management of nasopharyngeal carcinoma in a non-endemic area. The aim was to predict prognosis and detect recurrent and residual disease. In 72 patients, EBV DNA load in blood and nasopharyngeal brushes, and IgA VCA-p18 and EBNA1 in plasma were measured at different time points. At diagnosis and post-treatment, a cut-off value was used for detecting disease [positive (PPV) and negative (NPV) predictive value]. The markers were correlated as a continuous variable with tumor stage, disease-free survival (DFS) and overall survival (OS). The Cox hazard ratio model assessed hazard ratios. At diagnosis, the markers were above the COV in 45, 92, 85 and 83 % of the patients, respectively. Post-treatment, DNA load test in blood and brush had the best discriminating power (blood DNA load test: PPV 39 % and NPV 97 %, brush for local disease: PPV 75 % and NPV 99 %). Post-treatment, DNA load in blood was the best predictor for OS and DFS [hazard ratio 3.2 (95 % CI 1.51–3.5) and 2.3 (95 % CI 1.72–5.8)]. Assessing the EBV DNA load in blood has significant prognostic value, although the clinical value is for discussion. The EBV DNA load in the brush might improve early detection of local failures post-treatment.

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Acknowledgments

This study was funded by the Netherlands Cancer Foundation, KWF-NKI 2008-4233.

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Authors and Affiliations

  1. Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, The Netherlands

    Sharon D. Stoker, Maarten A. Wildeman, Renske Fles & I. Bing Tan

  2. Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands

    Maarten A. Wildeman

  3. Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands

    Zlata Novalic, Hedy Juwana, Octavia Ramayanti, Sandra A. W. M. Verkuijlen, Astrid E. Greijer & Jaap M. Middeldorp

  4. Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Vincent van der Noort

  5. Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands

    Remco de Bree

  6. Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands

    Weibel W. Braunius

  7. Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands

    Guido B. van den Broek

  8. Department of Radiotherapy, Institute for Radiation Oncology, Arnhem, The Netherlands

    Bas Kreike

  9. Department of Otolaryngology-Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands

    Kenneth W. Kross

  10. Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Jan Paul de Boer

  11. Department of Oral and Maxillofacial Surgery, Academic Medical Centre, Amsterdam, The Netherlands

    I. Bing Tan

  12. Department of Otorhinolaryngology, Gadjah Mada University, Yogyakarta, Indonesia

    I. Bing Tan

Authors
  1. Sharon D. Stoker
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  2. Maarten A. Wildeman
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  3. Zlata Novalic
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  4. Renske Fles
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  5. Vincent van der Noort
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  6. Remco de Bree
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  7. Weibel W. Braunius
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  8. Guido B. van den Broek
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  9. Bas Kreike
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  10. Kenneth W. Kross
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  11. Hedy Juwana
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  12. Octavia Ramayanti
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  13. Sandra A. W. M. Verkuijlen
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  14. Jan Paul de Boer
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  15. Astrid E. Greijer
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  16. Jaap M. Middeldorp
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  17. I. Bing Tan
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Correspondence to I. Bing Tan.

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Stoker, S.D., Wildeman, M.A., Novalic, Z. et al. Can Epstein-Barr virus DNA load in nasopharyngeal brushings or whole blood predict recurrent nasopharyngeal carcinoma in a non-endemic region? A prospective nationwide study of the Dutch Head and Neck Oncology Cooperative Group. Eur Arch Otorhinolaryngol 273, 1557–1567 (2016). https://doi.org/10.1007/s00405-015-3620-y

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  • DOI: https://doi.org/10.1007/s00405-015-3620-y

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