Relationship between pretreatment level of plasma Epstein-Barr virus DNA, tumor burden, and metabolic activity in advanced nasopharyngeal carcinoma

PURPOSE: Plasma Epstein-Barr virus DNA (pEBV DNA) is an important prognostic marker in nasopharyngeal carcinoma (NPC). This study tested the hypotheses that pEBV DNA reflects tumor burden and metabolic activity by evaluating its relationship with tumor volume and 18F-fluorodeoxyglucose (18F-FDG) uptake in NPC. METHODS AND MATERIALS: Pre-treatment pEBV DNA analysis, 18F-FDG positron emission tomography-computed tomography scan (PET-CT) and magnetic resonance imaging (MRI) of the head and neck were performed in 57 patients. Net volume (cm3) of the primary tumor (T(vol)) and regional nodes (N(vol)) were quantified on MRI. 18F-FDG uptake was expressed as the maximum standardized uptake value (SUV(max)) at the primary tumor (T(suv)) and regional nodes (N(suv)). Lesions with SUV(max) > or = 2.5 were considered malignant. Relationship between SUV(max), natural logarithm (log) of pEBV DNA, and square root (sq) of MRI volumes was analyzed using the Wilcoxon test. A linear regression model was constructed to test for any interaction between variables and disease stage. RESULTS: Log-pEBV DNA showed significant correlation with sq-T(vol) (r = 0.393), sq-N(vol) (r = 0.452), total tumor volume (sq-Total(vol) = T(vol) + N(vol), r = 0.554), T(suv) (r = 0.276), N(suv) (r = 0.434), and total SUV(max) (Total(suv) = T(suv) + N(suv), r = 0.457). Likewise, sq-T(vol) was correlated to T(suv) (r = 0.426), and sq-N(vol) with N(suv) (r = 0.651). Regression analysis showed that only log-pEBV DNA was significantly associated with sq-Total(vol) (p < 0.001; parameter estimate = 8.844; 95% confidence interval = 3.986-13.703), whereas Sq-T(vol) was significantly associated with T(suv) (p = 0.002; parameter estimate = 3.923; 95% confidence interval = 1.498-6.348). CONCLUSION: This study supports the hypothesis that cell-free plasma EBV DNA is a marker of tumor burden in EBV-related NPC.     

Prognostic value of serum Epstein–Barr virus antibodies in patients with nasopharyngeal carcinoma and undetectable pretreatment Epstein–Barr virus DNA

Epstein–Barr virus (EBV) is closely associated with nasopharyngeal carcinoma (NPC). Serum IgA antibodies against early antigen (EA‐IgA) and viral capsid antigen (VCA‐IgA) are the most commonly used to screen for NPC in endemic areas. However, the prognostic value of serum EA‐IgA and VCA‐IgA in patients with NPC is less clear. We hypothesize that serum EA‐IgA and VCA‐IgA levels have prognostic impact for survival outcomes in NPC patients with undetectable pretreatment EBV (pEBV) DNA. In this series, 334 patients with non‐metastatic NPC and undetectable pEBV DNA were included. Serum EA‐IgA and VCA‐IgA were determined by ELISA. After analysis, serum EA‐IgA and VCA‐IgA loads correlated positively with T, N, and overall stage (all P < 0.05). Serum EA‐IgA was not associated with survival outcome in univariable analyses. But patients with serum VCA‐IgA >1:120 had significantly inferior 5‐year progression‐free survival (80.4% vs 89.6%, P = 0.025), distant metastasis‐free survival (88.4% vs 94.8%, P = 0.050), and locoregional relapse‐free survival (88.4% vs 95.6%, P = 0.023; log–rank test). Multivariable analyses revealed that N stage was the only independent prognostic factor (all P < 0.05), but the VCA‐IgA became insignificant. Further analyses revealed that serum VCA‐IgA was not an independent prognostic factor in early N (N0–1) or advanced N (N2–3) stage NPC. In summary, although both EA‐IgA and VCA‐IgA correlate strongly with TNM stage, our analyses do not suggest that these antibodies are prognostic biomarkers in patients with NPC and undetectable pEBV DNA.     

鼻咽癌患者血浆游离EBV/DNA的定量检测及其临床意义

目的:探讨血浆EBV/DNA定量分析,在鼻咽癌早期诊断、临床分期、预后判断和监测放疗后转移复发中的临床意义.方法:采用荧光定量PCR方法定量检测经病理确诊为鼻咽癌的120例初治、90例放疗后随诊患者,其中包括60例放疗后持续缓解,30例远处转移和局部复发患者的血浆EBV/DNA含量.结果:初治、远处转移和局部复发的鼻咽癌患者血浆中游离的EBV/DNA检出率分别为96.0%、95.0%和100%,显著高于治疗后持续缓解鼻咽癌患者、健康对照者和非鼻咽癌的肿瘤患者;初治鼻咽癌患者各TNM分期之间血浆EBV/DNA拷贝数有显著统计学差异,晚期患者(Ⅲ Ⅳ)期血浆EBV/DNA中位拷贝数显著高于早期患者(I Ⅱ)期;初治患者治疗后已出现局部和远处转移者.治疗前血浆EBV/DNA中位数显著高于尚未出现复发转移患者:初治患者治疗前血浆EBV/DNA≥40 000拷贝/ml与＜40 000拷贝/ml两个水平,患者22个月无复发生存率分别为46.1%和92.9%,有显著统计学差异;放疗后复发、转移鼻咽癌患者血浆EBV/DNA的中位拷贝数显著高于治疗后持续缓解患者.结论:采用荧光定量PCR方法检测鼻咽癌患者血浆中游离的EBV/DNA是一种敏感可靠的方法,对于鼻咽癌早期诊断、鉴别诊断、分期、判断预后、监测治疗后复发和远处转移具有重要的临床意义,有可能成为鼻咽癌的血清肿瘤标记物.     

增强CT冠状扫描在诊断鼻咽癌颅底侵犯中的意义

目的：探讨鼻咽部增强CT冠状位扫描对诊断鼻咽癌侵犯颅底的价值。方法：将经病理学检验证实的193例鼻咽癌的CT增强轴位扫描与冠状位扫描颅底情况进行回顾性对照分析。结果：193例鼻咽癌中，120例(占62．2％)经两种扫描均未见颅底侵犯；10例(5．2％)轴位扫描未见颅底异常而经冠状扫描发现其受侵犯；15例(7．8％)轴位可疑颅底受侵犯而经冠状扫描肯定侵犯11例．排除4例；轴位扫描显示海绵受窦侵有26例。增强CT冠状扫描则为3例。结论：增强CT冠状扫描对确定鼻咽癌有无颅底骨质侵犯及其侵犯部位、范围与程度均有重要价值，在显示海绵窦受侵犯，肿瘤组织沿脑池或／和脑沟等蛛网膜下腔生长，侵犯周围组织的征像方面，明显优于轴位扫描。     

颅底补量放射对T4期鼻咽癌复发率的影响

背景与目的:有蝶窦、海绵窦侵犯的T4期鼻咽癌患者放疗后的颅底复发率较高。本研究探讨颅底补量对有蝶窦、海绵窦等侵犯的T4期鼻咽癌患者颅底复发率和生存率的影响。方法:从1996年10月至1998年11月,共有120例经病理组织学确诊为鼻咽癌、经CT诊断为筛窦、蝶窦或/和海绵窦侵犯的T4期鼻咽癌初治患者在我院住院接受放射治疗,鼻咽剂量为(71.55±3.09)Gy,颈部剂量为(58.95±6.16)Gy。其中27例在放射治疗后接受颅底补量6～10Gy(颅底补量组),93例未进行颅底补量(对照组)。有53例接受诱导化疗1～3疗程,其中对照组41例,颅底补量组12例。用Kaplan-Meier和log-rank法计算和比较两组生存率和局控率。结果:两组患者的临床资料比较无明显差别。对照组1、3、5年颅底控制率分别为93.4%、76.4%、65.1%,颅底补量组分别为100%、91.8%、86.8%,两组比较有显著性差异(P=0.045)。对照组1、3、5年无瘤生存率分别75.3%、45.2%、31.2%,中位无瘤生存期为30个月,颅底补量组分别为85.2%、59.3%、51.9%,中位无瘤生存期为60个月,两组比较无明显差异(P=0.084),对照组与颅底补量组的放射性脑损伤发生率分别为4.3%和7.4%,两组间无明显差异(P=0.514)。结论:颅底放射补量可减少蝶窦、海绵窦等侵犯的T4期鼻咽癌患者的颅底复发,对提高无瘤生存率有一定的益处,此类患者宜给予颅底补量。     

鼻咽癌海绵窦侵犯的MRI评价

目的探讨鼻咽癌侵犯海绵窦的发生率、主要侵犯途径及MRI特点。方法经病理证实并经MRI检查的鼻咽癌患者141例,使用1．5T超导MR机进行检查,增强扫描前行快速自旋回波（FSE）序列横断面T1WI、T2WI扫描,增强后采用快速扰相梯度回波（FSPGR）脂肪抑制序列横断面及冠状面扫描。由两位经验丰富的放射科医师读片。结果141例患者中,有39例（49侧）海绵窦受侵犯,发生率为27．7％。卵圆孔为最常见的单一侵犯途径,有18侧仅通过卵圆孔侵犯海绵窦,占36．7％;多途径侵犯海绵窦的患者中,有6侧（12．2％）经卵圆孔与破裂孔侵犯海绵窦,为最常见共同途径。最常见的MRI表现为海绵窦增大伴异常强化（22侧）,其次为海绵窦壁局限性或弥漫性增厚和（或）海绵窦内血管、神经结构紊乱或模糊不清（18侧）,海绵窦局部形成肿块者9侧。结论卵圆孔是鼻咽癌侵犯海绵窦的主要途径。MRI能有效、准确地判断鼻咽癌侵犯海绵窦的情况,对指导临床采取正确治疗措施具有重要价值。     

Prognostic factors of nasopharynx tumors investigated by MR imaging and the value of MR imaging in the newly published TNM staging

PURPOSE: To examine the usefulness of MR imaging for predicting local control of nasopharyngeal carcinoma (NPC) and the value of MR imaging in the newly published fifth edition of the TNM classification. METHODS AND MATERIALS: We studied 29 patients with NPC with MR imaging and CT before and after treatment. Staging was done according to the fourth and newly published fifth editions of the International Union Against Cancer (UICC) staging system. The radiotherapy protocol was designed to deliver 66 to 68 Gy to the primary tumor and clinically involved nodes. RESULTS: MR proved better than CT at identifying obliteration of the pharyngobasilar fascia, invasion of the sinus of Morgagni, through which the cartilaginous portion of the eustachian tube and the levator veli palatini muscle pass, invasion of the skull base, and metastases to lymph nodes in the carotid and retropharyngeal spaces. All seven patients without invasion of the pharyngobasilar fascia had local control. The local control rates of patients with invasion of the skull base were not good (60 to 73%). There was no apparent relationship between tumor volume determined by T1-weighted MR images and local control when the tumor volume was more than 20 cc. The newly published N staging system appears to successfully identify the high-risk group for distant metastasis as N3. In our series, four of five patients with N3 disease developed distant metastases. CONCLUSION: Deep infiltration of the tumor is a more important prognostic factor in NPC than tumor volume. Since the newly published T staging system requires a search for tumor invasion into soft tissue such as parapharyngeal space and bony structures, MR imaging may be indispensable for the newly published NPC staging system.     

鼻咽癌新鲜肿瘤组织DNA倍体性与预后的关系

背景与目的:因肿瘤有生物学异质性,部分肿瘤的预后和TNM分期并不符合;寻找有效的生物学预后指标作为临床分期的补充,可为今后鼻咽癌的个体化治疗提供一个新的依据.本研究探讨初治鼻咽癌患者新鲜肿瘤组织细胞的DNA倍体性与疗效、预后的关系.方法:1999年1月至2000年2月,53例初治鼻咽癌患者进入本研究,其中单纯放疗32例,另21例患者于放疗第4周接受了一个疗程的PF方案化疗.患者治疗前均活检取新鲜肿瘤组织,用流式细胞仪进行DNA倍体检测.结果:53例患者中,二倍体32例(60.4%),异倍体21例(39.6%).不同倍体组患者的年龄、性别、临床分期、N分期、化疗与否的差异无统计学意义(P=0.695、0.657、0.088、0.972和0.335).全组患者中位随访时间73个月(12～84个月).全组5年总生存率65.61%,其中二倍体组为80.92%,异倍体组为42.86%(P=0.002);5年无远处转移生存率二倍体组为84.26%,异倍体组为44.53%(P=0.003);5年无复发生存率二倍体组为92.59%,异倍体组为72.65%(P=0.118).单因素分析结果显示,临床分期是无复发生存率的影响因素,DNA倍体性、临床分期和T分期是总生存率和无远处转移生存率的影响因素.多因素分析结果显示,与总生存率相关的独立预后因素为DNA倍体性(P=0.020)和临床分期(P=0.007),与无转移生存率相关的预后因素亦为DNA倍体性(P=0.017)和临床分期(P=0.011).结论:采用流式细胞术检测新鲜组织细胞的DNA倍体性和临床分期一样可以预测鼻咽癌患者的预后;DNA异倍体患者比二倍体患者更容易出现远处转移而导致治疗失败.     

鼻咽癌调强放疗后长期生存结果及失败模式分析

目的 回顾分析IMRT治疗鼻咽癌的10年生存结果及失败模式,为鼻咽癌的优化治疗提供参考。方法 收集2001-2008年间865例采用IMRT的鼻咽癌患者的临床资料。生存分析采用Kaplan-Meier法,Logrank检验和单因素分析,Cox模型多因素预后分析。结果 中位随访时间为132.0个月,全组患者10年无局部复发生存(LRFS)、无远处转移生存(DMFS)、无进展生存(PFS)、肿瘤特异生存(DSS)分别为92.0%、83.4%、75.7%、78.6%。共210例死亡,其中124例(124/210,59.0%)死于远处转移, 47例(41/210,22.3%)死于局部区域复发。DSS的独立不良预后因素包括年龄>50岁(P=0.00)、LDH≥245 IU/L (P=0.00)、Hb<120 g/L (P=0.01)、T2-T4期(P=0.00)、N1-N3期(P=0.00)和GTV-nx>20 cm³(P=0.00)。Ⅱ期鼻咽癌患者单纯放疗组与联合化疗组10年LRFS、DMFS、DSS均相近(P=0.83、0.22、0.23),Ⅲ期鼻咽癌患者联合化疗组10年LRFS、DSS均优于单纯放疗组(P=0.01、0.01)但10年DMFS相近(P=0.14),Ⅳ a+Ⅳ b期患者总体预后较差。结论 IMRT改善了鼻咽癌患者的远期生存,远处转移成为最主要的失败模式;而Ⅰ-Ⅱ期患者采用单纯IMRT可取得满意生存结果,联合化疗可进一步提高Ⅲ期患者LRFS及DSS,而Ⅳ a+Ⅳ b期患者治疗模式仍需更多探讨。     

Better prediction of prognosis for patients with nasopharyngeal carcinoma using primary tumor volume

BACKGROUND: Heterogeneity of primary tumor volume within tumors of the same classification indicates a need to elucidate the effects of primary tumor volume on treatment outcomes in patients with nasopharyngeal carcinoma (NPC). METHODS: From 1994 through 1996, 129 patients with newly diagnosed NPC who were treated with high-dose radiotherapy were enrolled in the study. Computed tomography-derived primary tumor volume was measured using the summation-of-area technique. Correlations between American Joint Committee on Cancer (AJCC) disease stage, primary tumor volume, and disease-specific survival were assessed using a Cox regression model. Cross-validation based on receiver operating characteristic (ROC) curve also was examined. RESULTS: Compared with the AJCC staging system and the TNM classification system, primary tumor volume was better at determining cumulative survival for patients with NPC. Hazard ratios increased with tumor volume, ranging from 6.68 (95% confidence interval [95% CI], 1.89-23.67) for tumor volumes between 20-40 mL, 18.03 (95% CI, 4.80-67.75) for tumor volumes between 40-60 mL, and 26.06 (95% CI, 7.70-88.20) for tumor volumes > 60 mL. With both tumor volume and T classification in the same Cox regression model, only tumor volume remained statistically significant in the prognosis of NPC. The validation results with ROC curves also revealed that, in predicting patient outcome, primary tumor volume (area under the ROC = 83.33%) was superior to disease stage (area under the ROC = 66.53%) and TNM classification (area under the ROC = 58.61%). CONCLUSIONS: The incorporation of primary tumor volume may lead to a further refinement of the current AJCC staging system, particularly for patients with large primary tumor volumes (> 60 mL), who require more aggressive treatment. Cancer 2004.     

Dermatofibrosarcoma protuberans metastasizing to cavernous sinuses and lungs: a case report.

Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive tumor with a low potential for distant metastases. We report a 22-year-old female patient with a typical cutaneous DFSP who developed five local recurrences followed by left cavernous sinus metastasis at the eighth year and right cavernous sinus and lung metastases at the ninth year. In each local recurrence the tumor showed histological signs of progression as being more cellular, having higher mitotic index and being aggressively invasive through the underlying soft tissues. The histopathological evaluation of the metastatic tumor resected from the left cavernous sinus revealed dedifferentiation from low-grade DFSP to higher grade fibrosarcomatous morphology. Immunohistochemical studies of the primary tumor and also the recurrent and metastatic tumors showed diffuse CD34 positivity in all specimens and p53 positivity was detected in the metastatic tumor resected from left cavernous sinus.     

VEGF在鼻咽癌中的表达及其与预后关系

[目的]研究血管内皮生长因子（VEGF）在鼻咽癌中的表达与鼻咽癌患者预后的关系。[方法]通过组织芯片技术与免疫组织化学方法回顾性研究1990～2002年期间200例有临床随访资料的鼻咽癌组织中VEGF蛋白的表达情况，应用卡方检验分析鼻咽癌组织VEGF蛋白表达与临床病理参数之间的关系，并通过生存分析计算鼻咽癌组织内VEGF不同表达组的总生存率。[结果]VEGF在鼻咽癌组织中阳性表达主要位于肿瘤细胞胞浆内。VEGF在鼻咽癌组织中的表达与鼻咽癌患者的TNM分期、复发及远处转移呈正相关（P〈0．05）。VEGF表达阳性及阴性患者5年生存率分别为40．11％和67．75％，两组生存率存在显著性差异（P〈0．01）。[结论]VEGF的表达与鼻咽癌患者TNM分期、复发及远处转移呈明显正相关，其高表达提示预后不良。     

直肠腺癌75例新辅助放化疗肿瘤退缩分级相关临床病理因素分析

目的 通过评估直肠腺癌患者对新辅助放化疗的反应率,旨在探讨新辅助放化疗后组织学消退的预测因素.方法 回顾性分析2015-06-01-2018-05-31郑州大学附属肿瘤医院接受新辅助放化疗,并行手术治疗的75例局部进展期直肠腺癌患者的临床病理资料,KRAS、NRAS和BRAF基因通过等位基因特异性PCR或Sanger测...     

鼻咽癌的CT与MRI对比研究

目的:比较CT与MRI对鼻咽癌侵犯部位检出率的差别;评价MRI相对于CT对92分期产生的影响.方法:收集2003年1月至2004年6月收治、经病理证实的初诊鼻咽癌250例,所有病例同时具有治疗前鼻咽和颈部的CT及MRI资料.在CT和MRI上分别评价各个解剖部位的受侵犯情况.结合临床资料分别采用CT和MRI进行92分期.结果:MRI对于鼻咽超腔、茎突前间隙、口咽、咽后淋巴结、颅底骨质、海绵窦、鼻窦、颈椎和颞下窝等侵犯的检出率明显高于CT,有统计学意义.CT与MRI对于鼻腔、茎突后间隙侵犯及颈部淋巴结的检出差别无统计学意义.MRI使32.0%的T分期发生改变;11.6%的N分期发生改变;30.0%的临床分期发生改变.结论:MRI对于诊断鼻咽癌的超腔侵犯、颅底骨质、鼻窦、海绵窦受侵,以及咽后淋巴结转移要明显优于CT;而在颈部淋巴结转移的检出方面与CT结果一致.MRI主要影响鼻咽癌92分期的T分期;对N分期影响不大,临床分期的改变将有利于指引治疗方案的调整.     

Comparison of clinical and molecular surveillance in patients with advanced nasopharyngeal carcinoma after primary therapy: the potential role of quantitative analysis of circulating Epstein-Barr virus DNA

BACKGROUND: The importance of detecting recurrence at an early stage in patients with malignant disease is well recognized. Circulating Epstein-Barr virus (EBV) DNA can be detected in patients with nasopharyngeal carcinoma (NPC). The objective of the current study was to assess the effectiveness of plasma EBV DNA monitoring in the early detection of NPC recurrence compared with conventional methods. METHODS: Patients with NPC in two prospective clinical trials who had locoregional recurrences or distant metastases were recruited into the study. Clinical data on these patients were scrutinized for evidence of recurrence. EBV DNA copy numbers in the prospectively collected plasma samples were assayed retrospectively with real-time quantitative polymerase chain reaction analysis. RESULTS: At the time of clinical recurrence, 65% of 26 patients with locoregional recurrences and all but 1 of 28 patients with distant failure had circulating EBV DNA. The difference between the time from completion of treatment to positivity for circulating EBV DNA and the time from completion of treatment to the first observed clinical abnormality was not statistically significant for patients with local recurrence (P=0.84). However, the time to the first detection of circulating EBV DNA was significantly shorter among patients with distant metastases (P<0.0001). The Kaplan-Meier estimated median time to the emergence of plasma EBV DNA was 190 days, with a 95% confidence interval (CI) of 95-300 days, and the median time to the first observed clinical abnormality was 295 days (95% CI, 276-361 days). CONCLUSIONS: Monitoring plasma EBV DNA levels surpassed traditional methods for the early detection of distant failure in patients with NPC. The role of this technique should be evaluated in prospective studies that incorporate complementary advanced imaging technology.     

磁共振弥散加权成像对鼻咽癌靶区勾画和复发转移预测的临床价值研究

目的 探讨磁共振弥散加权成像(DWMRI)能否预测鼻咽癌调强放疗后复发和转移以及判断靶区范围的价值。方法 回顾 2008年6月起初次调强放疗的鼻咽癌病历资料,选择有复发或转移 36例和无复发转移 36例作对照。对两组病例在DWMRI上测量其疗前肿瘤表观弥散系数(ADC值),并行成组t检验推测ADC值是否能预测鼻咽癌复发和转移。回顾分析局部区域复发病例放疗前MRI,从影像学角度分析DWMRI是否有助于判断靶区范围。结果 复发或转移组、对照组疗前ADC均值分别为(0.753±0.091)×10^－3、(0.793±0.094)×10^－3 mm²/s (t=－1.79,P=0.078)。影像学回顾分析显示DWMRI在低本底上突显了肿瘤侵犯范围,局部区域复发共 16例,15例疗前常规MRI弥散序列在病变范围上一致,1例复发患者DWMRI序列较常规序列更准确地预测了病变复发部位。结论 DWMRI结合常规MRI可更准确地判断鼻咽癌靶区范围,但其疗前ADC值的高低与鼻咽癌复发或转移并无关联。     

Circulating tumor DNA correlates with tumor burden and predicts outcome in pancreatic cancer irrespective of tumor stage

IntroductionCirculating tumor DNA (ctDNA) represents a promising tool for diagnosis, prognosis and treatment monitoring of several malignancies. Its association with tumor burden in pancreatic ductal cancer (PDAC), especially in localized disease, is not fully explored yet. We aimed to investigate the association of pretherapeutic ctDNA levels in localized and metastatic PDAC with tumor volume and clinical outcomes.Material and methodsLiquid biopsy for ctDNA detection was prospectively obtained from patients with localized or disseminated PDAC prior to either resection or systemic treatment. Detection rates and levels of ctDNA (digital droplet PCR) were correlated to tumor volume, relapse rate and survival.Results60 patients with localized and 47 patients with metastatic PDAC were included. ctDNA was detected in 10% of localized and 57.4% of metastasized PDAC samples. In localized disease, ctDNA detection significantly correlated with the numbers of involved locoregional lymph nodes (p = 0.030). Primary tumor volume did not correlate with ctDNA levels in neither localized (p = 0.573) nor metastasized disease (p = 0.878). In disseminated disease, ctDNA levels correlated with total tumor volume (p = 0.026) and especially with liver metastases volume (p = 0.004), but not with other metastases. Detection of pretherapeutic ctDNA was associated with shorter DFS in localized (3.3 vs. 18.1 months, p = 0.000), whereas ctDNA levels were associated with worse survival in metastatic PDAC (5.7 vs. 7.8 months, p = 0.036).ConclusionctDNA positivity indicates major nodal involvement or even presence of undetected distant metastases associated with early recurrence in localized PDAC. Moreover, it predicts worse clinical outcome in both localized and metastatic disease.     

鼻咽癌调强放射治疗结束时T残留的影响因素分析

目的 分析鼻咽癌（nasopharyngeal carcinoma，NPC）放疗结束时T残留的影响因素，减少T残留，提高NPC患者疗效。 方法 收集2008年6月至2016年6月在广西某三级甲等医院住院治疗的691例NPC患者的临床资料，分析放疗结束时T残留情况及相关影响因素，计算残留率，采用logistic回归模型进行危险因素筛选。结果 691例NPC患者中发生T残留227例，残留率为32.85%。单因素分析显示，年龄≥50岁组残留率高于年龄＜50岁组（39.91% vs 29.60%；χ²=7.191， P=0.007）；男性残留率高于女性（35.12% vs 26.74%；χ²=4.343，P=0.037）；不同临床分期残留率、T分期残留率比较，差异有统计学意义（P<0.001）；口咽、喉咽、鼻腔、椎前肌、颈动脉鞘区、翼内肌、翼外肌、颅底、鼻窦、颞下窝、颅内、海绵窦、颅神经和喉咽等部位有肿瘤侵犯组残留率均高于无侵犯组（P＜0.05）。多因素分析结果显示，男性、年龄≥50岁和口咽、颅底、海绵窦、颅神经等部位有肿瘤侵犯是NPC放疗结束发生T残留的独立影响因素（P＜0.05）。 结论 制定NPC放疗方案时，充分考虑性别、年龄因素和口咽、颅底、海绵窦、颅神经等部位有无肿瘤侵犯，可有效减少T残留。     

A phase II study of patients with metastatic or locoregionally recurrent nasopharyngeal carcinoma and evaluation of plasma Epstein–Barr virus DNA as a biomarker of efficacy

Background The epidermal growth factor receptor (EGFR) is commonly overexpressed in nasopharyngeal carcinoma (NPC) and gefitinib inhibits NPC growth in vitro. Method Patients who progressed after prior platinum-based chemotherapy for recurrent NPC were given gefitinib orally at 500 mg/day at a 28-day cycle. Plasma Epstein–Barr virus (pEBV) DNA levels were obtained at specific intervals. Results Sixteen patients enrolled and 15 were evaluable for response. The median age was 49 years (range 34–64 years), and most patients were males with metastatic NPC. No objective response was seen and three patients had stable disease (SD) for 2.8 to 8.5 months. Radiological progression of disease coincided with rising levels of pEBV DNA in most patients, while the level of a patient with the longest duration of SD fell to an undetectable level at study completion. The mean time to progression and overall survival was 2.7 (standard error, SE +/− 0.5 months) and 12 months (SE +/− 1.7 months), respectively. No unexpected drug-related toxicities were seen. The study was prematurely terminated because there was insufficient activity to warrant progression to the second stage of accrual. Conclusion This study found limited activity of gefitinib in recurrent NPC. Further evaluation of pEBV DNA as a biomarker of response in clinical trials of target-based agents is warranted.