BACKGROUND The current study was performed to investigate whether circulating cell-free Epstein-Barr virus DNA (cfEBV DNA) would be useful for posttreatment surveillance in patients with nasopharyngeal carcinoma (NPC). METHODS The authors identified a total of 1984 nondisseminated NPC patients from an institutional big-data research platform. Blood samples were collected within 3 months of the completion of radiotherapy and every 3 to 12 months thereafter for cfEBV DNA analysis. Patients were followed until disease recurrence was detected or for a median of 60 months. Diagnostic performance was assessed by calculating the sensitivity, specificity, and accuracy based on the clinical detection of disease recurrence by conventional surveillance modalities (imaging scans and pathological examination). RESULTS During follow-up, a total of 767 patients (38.7%) had detectable cfEBV DNA. The recurrence rate among these patients was 63.8% (489 of 767 patients), which was significantly higher than that in patients with undetectable cfEBV DNA (8.6%; 105 of 1217 patients). cfEBV DNA sensitivity, specificity, and accuracy were 68.8%, 80.0%, and 78.2%, respectively, for local recurrence; 80.2%, 80.0%, and 85.9%, respectively, for regional recurrence; and 91.1%, 80.0%, and 92.8%, respectively, for distant metastasis. cfEBV DNA was found to have higher sensitivity for the detection of extrapulmonary metastases (94.9%-96.5%) compared with pulmonary metastases (78.4%). It is interesting to note that among the patients with disease recurrence with detectable cfEBV DNA, positive cfEBV DNA results preceded radiological and/or clinical evidence of disease recurrence by a median of 2.3 months (interquartile range, 0.1-9.5 months). In addition, of the 278 cfEBV DNA-positive patients who did not develop disease recurrence, 227 (81.7%) had transiently positive cfEBV DNA that fell to undetectable levels during long-term monitoring. CONCLUSIONS Plasma cfEBV DNA in patients with NPC appears to be an early sign of tumor recurrence, especially extrapulmonary metastases.

中文翻译：

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液体活检跟踪在非转移性鼻咽癌患者治疗后监测中的预后潜力。

背景技术进行本研究以调查循环的无细胞爱泼斯坦-巴尔病毒DNA（cfEBV DNA）是否可用于鼻咽癌（NPC）患者的治疗后监测。方法作者从一个机构大数据研究平台中识别出了1984名未传播的NPC患者。在放疗完成后的3个月内收集血样，此后每3到12个月收集血样用于cfEBV DNA分析。跟踪患者直至发现疾病复发或中位数为60个月。通过基于常规监视方式（影像扫描和病理学检查）对疾病复发的临床检测，通过计算敏感性，特异性和准确性来评估诊断性能。结果在随访中，共有767名患者（38.7％）有可检测的cfEBV DNA。这些患者的复发率为63.8％（767例患者中的489例），显着高于无法检测到cfEBV DNA的患者（8.6％； 1217例患者中的105例）。cfEBV DNA局部复发的敏感性，特异性和准确性分别为68.8％，80.0％和78.2％。区域复发率分别为80.2％，80.0％和85.9％；远处转移分别为91.1％，80.0％和92.8％。发现cfEBV DNA对肺外转移的检测灵敏度更高（94.9％-96.5％），而肺转移的检测灵敏度更高（78.4％）。有趣的是，在具有可检测到的cfEBV DNA的疾病复发患者中，cfEBV DNA阳性结果在疾病复发的放射学和/或临床证据之前的中位数为2。3个月（四分位间距为0.1-9.5个月）。此外，在278名未发生疾病复发的cfEBV DNA阳性患者中，有227名（81.7％）的短暂性cfEBV DNA暂时阳性，在长期监测中降至无法检测的水平。结论NPC患者血浆cfEBV DNA似乎是肿瘤复发的早期迹象，尤其是肺外转移。