JAMA Netw Open:血浆EBV DNA水平与复发或转移性鼻咽癌患者接受抗PD-1治疗预后的相关性

2022-03-11 yd2015 MedSci原创

研究表明,血浆EBV DNA是复发或转移性鼻咽癌(RM-NPC)接受抗PD-1单药治疗患者的预后指标,并且可用于监测疾病进展。

近期,中山大学肿瘤防治中心的王风华和韩非教授在JAMA Netw Open杂志上发表了一项研究成果,主要是基于POLARIS-02研究,探讨血浆EBV DNA水平在复发或转移性鼻咽癌(RM-NPC)接受抗PD-1单药治疗的患者预后预测和疾病进展监测中的作用。

2016年12月22日至2019年2月19日,全国17个参与中心筛查了279例RM-NPC患者;纳入190例患者并随访至2020年2月19日。治疗前检测血浆EBV DNA水平,并且每4周检测一次直至疾病进展。研究终点是血浆EBV DNA作为无进展生存期(PFS)、总生存期(OS)、持久临床获益(定义为≧6个月的PFS)和疾病进展的预测因子。

190例患者中,11例缺乏基线EBV DNA水平数据被排除,最终179例接受抗PD-1治疗的RM-NPC患者纳入基线分析队列,148例(82.7%)为男性,中位年龄为46岁(22-71岁)。31例患者因为第一个4周前出现进展或失访而被排除,因此,148例患者纳入有动态EBV DNA水平资料的队列中。

179例患者中,以EBV DNA 10 000 IU/mL为分界点,低于10 000 IU/mL为低水平组,有75例患者,而高于10 000 IU/mL为高水平组,有104例患者。基线高EBV DNA水平组患者的中位PFS明显短于基线低EBV DNA水平组患者(1.8个月[IQR, 1.8-2.7个月] vs 3.7个月[IQR, 1.9-11.0个月];HR=1.70;95%CI,1.21-2.40;P =0.002)以及中位OS(11.1个月[IQR, 8.9-20.1个月] vs 22.9个月[IQR, 18.6个月-未达到];HR=1.88;95%CI,1.22-2.89;P =0.004)。

148例动态检测EBV DNA水平的患者中,根据第4周(W4)与基线的比值将患者分为2组:≤0.5 (n = 60)和>0.5 (n = 88)。比值>0.5患者的中位PFS(1.8个月vs 11.0个月);HR=3.42;95%CI,2.28-5.11;P<0.001)和中位OS(11.2个月[IQR, 9.3-20.4个月 vs未达到[IQR, 21.5个月-未达到];HR=2.18;95%CI,1.30-3.65;P =0.002)明显差于比值≦0.5患者。

基线低EBV DNA水平组患者(n = 71)的DCB率显著高于高基线EBV DNA水平组患者(n = 97)(27例[38.0%]vs 19例[19.6%];P<0. 05)。比值≦0.5患者的DCB率(59.3%) 高于比值>0.5患者(10.5%)(P<0.001)。获得DCB患者的中位W4/基线比值低于没有获得DCB患者 (0.20 [IQR, 0.03-0.40] vs 1.02 [IQR, 0.53-1.68]; P <0.001)。

35例获得完全缓解、部分缓解和疾病稳定并最终进展的患者中,EBV DNA水平增加较影像学进展提前中位2.6个月(IQR, 0.9-4.5个月)。

综上,研究表明,血浆EBV DNA是复发或转移性鼻咽癌(RM-NPC)接受抗PD-1单药治疗患者的预后指标,并且可用于监测疾病进展。

原始出处:

Xu JY, Wei XL, Ren C, Zhang Y, Hu YF, Li JY, Chen JL, Wang YQ, Han F, Wang FH. Association of Plasma Epstein-Barr Virus DNA With Outcomes for Patients With Recurrent or Metastatic Nasopharyngeal Carcinoma Receiving Anti-Programmed Cell Death 1 Immunotherapy. JAMA Netw Open. 2022 Mar 1;5(3):e220587. doi: 10.1001/jamanetworkopen.2022.0587. PMID: 35230439; PMCID: PMC8889459.

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    2022-12-14 wgx306
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    2022-06-27 canlab
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    2022-09-08 feather89
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