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[目的]探讨初治鼻咽癌患者治疗前血浆EBV DNA表达水平的预后价值。[方法]回顾分析667例初诊鼻咽癌接受根治性调强放疗患者的临床资料,分析治疗前血浆EBV DNA与临床分期、总生存的关系。以1500拷贝数/ml为临界值,将患者分为EBV DNA高表达者和低表达者。Kaplan-Meier法计算生存率并用Log-rank法检验,多因素分析采用Cox模型分析。[结果]Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者中EBV DNA>0拷贝数/ml的比率分别为18.8%、34.4%、50.5%、66.4%。患者治疗前血浆EBV DNA的表达量与临床分期呈正相关(P<0.001)。临床分期和EBV DNA是患者总生存的独立预后因素。Ⅲ期患者中,EBV高低者两组差别具有统计学意义(χ2=4.084,P=0.043),EBV DNA还是Ⅲ期患者总生存的独立预后因素。Ⅰ~Ⅱ期及Ⅳ期患者中,EBV DNA高低两组总生存率差别无统计学意义,但多因素分析发现,EBV DNA的绝对拷贝数是总生存的独立预后因素(P<0.05)。[结论]治疗前血浆EBV DNA对于各期鼻咽癌患者均具有预后作用,对于Ⅲ期患者,以1500拷贝数/ml为临界值,可以较好地判断预后,但对于Ⅰ~Ⅱ期及Ⅳ期患者,还需要更多的研究以确定合适的临界值。
[Objective] To investigate the prognostic value of plasma EBV DNA level in patients with newly diagnosed nasopharyngeal carcinoma before treatment. [Methods] The clinical data of 667 newly diagnosed nasopharyngeal carcinoma patients receiving radical intensity modulated radiotherapy were retrospectively analyzed. The relationship between plasma EBV DNA and clinical stage and overall survival was analyzed before treatment. At 1500 copies / ml as a cutoff, patients were divided into EBV DNA high expression and low expression. Kaplan-Meier survival rates calculated by Log-rank test, multivariate analysis using Cox model analysis. [Results] The rates of EBV DNA> 0 copies / ml were 18.8%, 34.4%, 50.5% and 66.4% in stage Ⅰ, Ⅱ, Ⅲ and Ⅳ respectively. The plasma EBV DNA level before treatment was positively correlated with clinical stage (P <0.001). Clinical staging and EBV DNA are independent prognostic factors for overall patient survival. In stage Ⅲ patients, EBV DNA was also an independent prognostic factor of overall survival in patients with stage Ⅲ EBV, the difference between the two groups was statistically significant (χ2 = 4.084, P = 0.043). There was no significant difference in the overall survival rates of EBV DNA between stage Ⅰ ~ Ⅱ and stage Ⅳ, but multivariate analysis showed that the absolute copy number of EBV DNA was an independent prognostic factor for overall survival (P <0.05). [Conclusion] The plasma EBV DNA before treatment has a prognostic value for all stages of NPC. The cut-off value of 1500 copies / ml for stage III patients can be used to judge the prognosis better. However, for stage Ⅰ ~ Ⅱ and Ⅳ Patients, but also need more research to determine the appropriate threshold.