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Significance of Dynamic Changes of VCA-IgA Levels in Pre- and Post-treatment Plasma of Patients with Nasopharyngeal Carcinoma: Development of a Clinically-Oriented Model

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Abstract

Introduction

Nasopharyngeal carcinoma (NPC) responds well to radiotherapy but recurrence and metastasis are common. Currently, there is no widely used biomarker for accurately predicting the recurrence and metastasis of NPC. In this study, we aimed to evaluate the prognostic ability of Epstein–Barr virus (EBV) capsid antigen (VCA-IgA) kinetics by assessing the dynamic changes of VCA-IgA levels in the pre- and post-treatment plasma of patients with NPC and have proposed a prognostic model for clinical use.

Methods

The clinical records of patients with NPC diagnosed at Sun Yat-sen University Cancer Center were retrieved and classified into a respondent (n = 83) or non-respondent (n = 25) cohort based on their response to antitumor therapy. Factors associated with the outcomes of the patients were assessed and incorporated in a nomogram. For internal validation, bootstrapping with 1000 resamples was used. The prediction accuracy and discriminative ability of the nomogram were investigated by calibration and concordance index (C-index) and plotted decision curves to assess the benefits of nomogram-assisted decisions in a clinical context.

Results

Plasma VCA-IgA level of the non-respondent cohort at the 6th month after treatment was found significantly higher than the respondent cohort. Post-treatment VCA-IgA level, smoking, and distant metastases were identified as independent risk factors for disease-free survival (DFS), and were used to stratify patients with NPC into three risk groups. The median DFS of the low-, middle- and high-risk groups were 48.5, 35.0, and 15.5 months, respectively. The C-index of the nomogram was 0.848 (95% CI 0.769–0.926), demonstrating good clinical accuracy for predicting the DFS of patients with NPC. The decision curve showed that the nomogram in predicting DFS was better than VCA-IgA level, smoking, and distant metastases.

Conclusion

The proposed VCA-IgA-based nomogram demonstrated a promising ability to predict the DFS of patients with NPC after antitumor therapy. It could be used as a clinical guidance to improve the therapeutic/surveillance strategies of these patients.

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Acknowledgements

We thank the staff of the biochemical laboratory of Sun Yat-sen University Cancer Center who provided various biochemical markers, and all of the staff who supported this study.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article. The journal’s Rapid Service Fee was funded by the authors.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Author Contributions

Wen Liu and Minjie Mao contributed to the conception and design of the study and drafted the manuscript; Huilan Li, Hui Sheng and Boyu Tian contributed to data analysis and interpretation; Peidong Chi and Kewei Huang participated in data collection and literature research. All authors read and approved the final manuscript.

Disclosures

All named authors (Minjie Mao, Hui Sheng, Boyu Tian, Peidong Chi, Kewei Huang, Huilan Li and Wen Liu) have nothing to disclose.

Compliance with Ethics Guidelines

This study was performed in accordance with the Helsinki Declaration of 1964 and its later amendments. In addition, the Institute Research Ethics Committee of the Sun Yat-Sen University Cancer Center approved the study (NO: SL-B2023-030-01). All patients provided written informed consent.

Data Availability

The authenticity of this article has been validated by uploading the key raw data onto the Research Data Deposit public platform (www.researchdata.org.cn), with the approval RDD number as RDDA2023593889.

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Author notes

  1. Minjie Mao, Hui Sheng and Boyu Tian contributed equally to this work as first authors.

Authors and Affiliations

  1. Department of Laboratory Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, Guangdong, People’s Republic of China

    Minjie Mao, Boyu Tian, Peidong Chi, Kewei Huang & Wen Liu

  2. Department of Experimental Research, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, Guangdong, People’s Republic of China

    Hui Sheng

  3. Department of Laboratory Medicine, Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, 518000, Guangdong, People’s Republic of China

    Huilan Li

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  1. Minjie Mao
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Correspondence to Huilan Li or Wen Liu.

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Mao, M., Sheng, H., Tian, B. et al. Significance of Dynamic Changes of VCA-IgA Levels in Pre- and Post-treatment Plasma of Patients with Nasopharyngeal Carcinoma: Development of a Clinically-Oriented Model. Adv Ther 40, 2426–2438 (2023). https://doi.org/10.1007/s12325-023-02493-2

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