We aimed to evaluate the effectiveness of nasopharyngeal cancer (NPC) screening by comprehensive clinical follow-up and adjunctive Epstein-Barr virus (EBV) testing. In a prospective cohort study, 524 individuals with a first-degree family history of NPC were recruited at a university clinical center in Singapore. The cohort was evaluated at baseline and at 6 monthly intervals, with a complete head and neck examination including nasopharyngeal endoscopy. Blood was taken at baseline and at yearly intervals for EBV Viral Capsid Antigen (VCA) IgA, EBV Early Antigen (EA) IgA serology and serum cell-free EBV DNA. Nasopharyngeal biopsy was performed when any irregularity in the nasopharynx was observed, or when EBV markers were elevated. The mean duration of follow-up was 57.7 months, with an average of 8.6 clinical visits per participant. Five participants (0.96%) were identified to have NPC, giving a prevalence of 199 per 100,000 person-years of screening. Four of the five NPC cases identified had asymptomatic T1 disease, at an earlier stage compared to NPC patients diagnosed in the clinic during the same time period (p = 0.0297). All NPC cases identified had elevated EBV-EA IgA titers ≥1:10, with a specificity of 94.6% and a positive predictive value of 15.2%, outperforming EBV-VCA IgA and serum EBV DNA. Two NPC cases were biopsied only because of elevated EBV serology titers, with increasing EBV-EA IgA titers preceding the diagnosis of NPC. In conclusion, screening for NPC is effective in identifying early-stage disease. Adjunctive EBV-EA IgA testing improved the effectiveness of screening.

中文翻译：

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EBV血清学和血清无细胞DNA作为鼻咽癌筛查工具的比较：新加坡NPC筛查队列的结果。

我们旨在通过全面的临床随访和辅助性爱泼斯坦-巴尔病毒（EBV）测试来评估鼻咽癌（NPC）筛查的有效性。在一项前瞻性队列研究中，在新加坡的大学临床中心招募了524名具有NPC一级家族史的人。在基线和每6个月间隔对队列进行评估，并进行包括鼻咽内窥镜检查在内的完整头颈检查。EBV病毒衣壳抗原（VCA）IgA，EBV早期抗原（EA）IgA血清学和血清无细胞EBV DNA在基线和每年间隔采集。当观察到鼻咽有任何不规则或EBV标记升高时，进行鼻咽活检。平均随访时间为57.7个月，每位参与者平均进行8.6次临床随访。鉴定出五名参与者（0.96％）患有NPC，其患病率为每100,000人年199例。与在同一时期在诊所诊断出的NPC患者相比，所鉴定的5例NPC病例中有4例具有无症状的T1疾病（p = 0.0297）。鉴定出的所有NPC病例的EBV-EA IgA滴度均升高≥1：10，特异性为94.6％，阳性预测值为15.2％，优于EBV-VCA IgA和血清EBV DNA。仅在EBV血清学滴度升高的情况下对2例NPC进行活检，而在诊断NPC之前EBV-EA IgA滴度却增加了。总之，筛查NPC可有效识别早期疾病。辅助EBV-EA IgA检测提高了筛查的效率。筛选的000人年。与在同一时期在诊所诊断出的NPC患者相比，在所鉴定的5例NPC病例中有4例具有无症状的T1疾病（p = 0.0297）。鉴定出的所有NPC病例的EBV-EA IgA滴度均升高≥1：10，特异性为94.6％，阳性预测值为15.2％，优于EBV-VCA IgA和血清EBV DNA。仅在EBV血清学滴度升高的情况下对2例NPC进行活检，而在诊断NPC之前EBV-EA IgA滴度却增加了。总之，筛查NPC可有效识别早期疾病。辅助EBV-EA IgA检测提高了筛查的效率。筛选的000人年。与在同一时期在诊所诊断出的NPC患者相比，所鉴定的5例NPC病例中有4例具有无症状的T1疾病（p = 0.0297）。鉴定出的所有NPC病例的EBV-EA IgA滴度均升高≥1：10，特异性为94.6％，阳性预测值为15.2％，优于EBV-VCA IgA和血清EBV DNA。仅在EBV血清学滴度升高的情况下对2例NPC进行活检，而在诊断NPC之前EBV-EA IgA滴度却增加了。总之，筛查NPC可有效识别早期疾病。辅助EBV-EA IgA检测提高了筛查的效率。与同期在临床中诊断出的NPC患者相比处于早期（p = 0.0297）。鉴定出的所有NPC病例的EBV-EA IgA滴度均升高≥1：10，特异性为94.6％，阳性预测值为15.2％，优于EBV-VCA IgA和血清EBV DNA。仅在EBV血清学滴度升高的情况下对2例NPC进行活检，而在诊断NPC之前EBV-EA IgA滴度却增加了。总之，筛查NPC可有效识别早期疾病。辅助EBV-EA IgA检测提高了筛查的效率。与同期在临床中诊断出的NPC患者相比处于早期（p = 0.0297）。鉴定出的所有NPC病例的EBV-EA IgA滴度均升高≥1：10，特异性为94.6％，阳性预测值为15.2％，优于EBV-VCA IgA和血清EBV DNA。仅在EBV血清学滴度升高的情况下对2例NPC进行活检，而在诊断NPC之前EBV-EA IgA滴度却增加了。总之，筛查NPC可有效识别早期疾病。辅助EBV-EA IgA检测提高了筛查的效率。在诊断NPC之前，EBV-EA IgA滴度增加。总之，筛查NPC可有效识别早期疾病。辅助EBV-EA IgA检测提高了筛查的效率。在诊断NPC之前，EBV-EA IgA滴度增加。总之，筛查NPC可有效识别早期疾病。辅助EBV-EA IgA检测提高了筛查的效率。