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1、Outline,Introduction of nasopharynxIntroduction of nasopharyngeal carcinoma(NPC)Related articles of EBV DNA and NPC prognosis-EBV DNA level and NPC recurrence-EBV DNA level and distant metastasis-EBV DNA level and survival-EBV DNA level and treatment response,The nasopharynx(nasal part of the pharyn
2、x)is the uppermost part of the pharynx It extends from the base of the skull to the upper surface of the soft palate,Nasopharynx,Fossa of Rosenmuller,Nasopharynx,Examination of Nasopharynx,Nasopharyngoscope,Fossa of Rosenmuller,Nasopharyngeal Carcinoma(NPC),Epidemiology-Common in southern regions of
3、 China,particularly in Guangdong,Fujian,Hong-kong and Taiwan 150 cases per 100,000 people in Guangdong,7.7 cases per 100,000 people in Taiwan,and 0.11.7 per 100,000 people in USANPC is seen primarily in middle-aged(4555 y/o)persons in Asia,a high proportion of African cases appear in children,Etiolo
4、gy-Cause?Not clearEB virus-related to undifferentiated typeGene-(HLA-A2,Aw19,BSin 2,B17,BW16)Diet(salted vegetables,fish and meat-dimethylnitrosamines)Environment smoking,nickel exposure,formaldehyde(甲醛),Nasopharyngeal Carcinoma(NPC),NPC,Normal,Symptoms and Signs,Neck massEar fullness and hearing im
5、pairment(middle ear effusion)Blood tingled sputumNasal obstruction Headache Diplopia,Diagnosis and Treatment,Biopsy!Treatment Radiotherapy+/-chemotherapy Operation(salvage),Related Articles of EBV DNA and NPC prognosis,EBV DNA level and NPC recurrence,EBV DNA level and NPC recurrence,Plasma/serum ce
6、ll-free EBV DNA may be a valuable tool for the monitor of NPC patients for the early detection of tumor recurrence Lo YM.et al.Cancer Res.1999 Circulating EBV DNA has been found not only to correlate with disease staging,but also to provide useful information for the monitoring for tumor recurrence
7、Lo YM.et al.Biomed Pharmacother.2001.ReviewThe failure of complete and rapid elimination of EBV DNA from the circulation predicts disease recurrence To EW.et al.Clin Cancer Res.2003,This study provide convincing evidence for the use of plasma EBV DNA measurements for the early diagnosis and staging
8、of NPC a well as for monitoring recurrence and metastasis of this tumor Shao JY.et al.Cancer.2004The usefulness of EBV DNA as a useful tool in monitoring NPC by its ability to detect early recurrence and excellent correlation with treatment response Chan SL et al.BMC Cancer.2006The plasma EBV DNA as
9、say correctly predicted all NPC recurrences,and PET had high capacity to localize potential lesion sites Wang WY et al.Cancer.2011,EBV DNA level and NPC recurrence,The risks of loco-regional failure were not significantly different between patients with high and those with low EBV DNA levels Leung S
10、F.et al.Cancer.2003Plasma EBV DNA load measurement appears to be useful in a low tumor risk area(western Europe).However,development of local recurrences may not always coincide with raised level of EBV DNA Kalpoe JS.et al.J Clin Pathol.2006,EBV DNA level and NPC recurrence,Conclusion-NPC recurrence
11、 was highly related to EBV DNA level,but not always coincidedWith an asymptomatic rise in the plasma EBV DNA level,tumor recurrence should be considered,EBV DNA level and NPC recurrence,EBV DNA level and distant metastasis,EBV DNA level and distant metastasis,Patients with distant failure had signif
12、icantly higher pre-therapy EBV DNA levels than those without failure Leung SF.et al.Cancer 2003,Kaplan Meier plot of freedom from distant failure for patient subgroups with high versus low pretherapy Epstein Barr virus(EBV)DNA levels,The time to the first detection of circulating EBV DNA was signifi
13、cantly shorter among patients with distant metastasis.Monitoring plasma EBV DNA level surpassed traditional methods for the early detection of distant failure in patients with NPC Hong RL.et al.Cancer.2004 The use of plasma EBV DNA measurements for the early diagnosis and staging of NPC a well as fo
14、r monitoring recurrence and metastasis of this tumor Shao JY.et al.Cancer 2004,EBV DNA level and distant metastasis,Conclusion-EBV DNA level was highly related to distant metastasisClose monitoring EBV DNA level could early detect distant failure in NPC patients,EBV DNA level and distant metastasis,
15、EBV DNA level and survival,Levels of post-treatment plasma EBV DNA in patients with NPC appear to strongly predict progression-free and overall survival and to accurately reflect the post-treatment residual tumor load Chan AT.et al.J Natl Cancer inst.2002Pre-therapy circulating EBV DNA load is an in
16、dependent prognostic factor for overall survival in NPC Leung SF.et al.J Clin Oncol.2006,EBV DNA level and survival,Survival probabilities of patient groups according to Epstein-Barr virus(EBV)DNA levels.Low DNA denotes low EBV DNA levels of less than 4000 copies/ml,and high DNA denotes high EBV DNA
17、 levels of 4000 copies/ml Leung SF.et al.J Clin Oncol.2006,EBV DNA status remains a strong predictor for overall survival in NPC Kenneth WY.et al.Clin Cancer Res.2006Metastatic/recurrent NPC patients with low pre-treatment plasma EBV DNA level and undetectable post-treatment plasma EBV DNA showed a
18、favorable prognosis and survival An X.et al.Cancer.2011,EBV DNA level and survival,The 5-year overall survival rate in low pre-treatment plasma EBV DNA level and undetectable post-treatment plasma EBV DNA subgroup was 50.6%.However,no patients in the other 3 subgroups survived 5 years An X.et al.Can
19、cer.2011,Conclusion-EBV DNA level was highly related to survival rateLower pre-treatment plasma EBV DNA level and undetectable post-treatment plasma EBV DNA showed the best prognosis,EBV DNA level and survival,EBV DNA level and treatment response,EBV DNA level and treatment response,Rapid clearance
20、of plasma Epstein-Barr virus DNA after surgical treatment of nasopharyngeal carcinoma To EW.et al.Clin Caner Res.2003The in vivo elimination of EBV DNA is very rapid after surgical resection of NPCThe failure of complete and rapid elimination of EBV DNA from the circulation predicts disease recurren
21、ce,Plasma EBV DNA clearance rate as a novel prognostic marker for metastatic/recurrent nasopharyngeal carcinoma Wang WY.et al.Clin Cancer Res.2010Patients with a short t1/2 of plasma EBV DNA clearance have significantly higher complete response rate and overall survival than those with long t1/2 The
22、 plasma EBV DNA concentrations have no significant effects on outcome prediction,EBV DNA level and treatment response,The plasma EBV DNA concentrations have no significant effects on outcome predictionThe t1/2 of plasma EBV DNA clearance shows significant effects on tumor response,The clearance rate
23、s of plasma EBV DNA during the first month of chemotherapy can predict tumor response and patient survivalEarly change of chemotherapy regimen may be considered for patients with slow plasma EBV DNA clearance rate Wang WY.et al.Clin Cancer Res.2010,EBV DNA level and treatment response,Conclusion-EBV
24、 DNA level was a useful tool to monitor tumor response after therapyThe clearance rates of plasma EBV DNA seemed better than the concentration of plasma EBV DNA in predicting tumor response,EBV DNA level and treatment response,Conclusion,EBV DNA level was a useful tool in monitoring tumor recurrence,distant metastasis,survival and treatment response in nasopharyngeal carcinoma,Thanks for Your Attention!,
