血浆EB病毒DNA定量监测在局部晚期鼻咽癌治疗及随访中的临床意义

目的 探讨在局部晚期鼻咽癌患者同步放化疗综合治疗及随访中动态监测血浆EB病毒DNA（EBV-DNA）定量水平的作用。方法 采用荧光定量PCR技术检测156例局部晚期鼻咽癌患者同步放化疗综合治疗前及治疗2、4、6、8周血浆EBV-DNA定量水平，并对治疗前血浆EBV-DNA阳性且获随访的患者在治疗后6、12、18和24个月的血浆EBV-DNA定量进行检测。治疗结束后评价疗效并随访治疗后2年的复发转移情况。结果 156例患者治疗前的血浆EBV-DNA阳性率为91.0％（142／156），治疗8周的阳性率仅9.6％（15／156）。治疗前血浆EBV-DNA阳性的142例患者中，127例血浆EBV-DNA水平从治疗2周开始下降，至治疗6周未检测出DNA复制；其余15例在治疗8周内血浆EBV DNA水平维持阳性。治疗结束后，获完全缓解119例和部分缓解37例，其治疗8周的血浆EBV-DNA阳性率分别为3.4％（4／119）和29.7％（11／37）。142例治疗前血浆EBV-DNA阳性患者中有135例获随访2年，1、2年复发转移率分别为14.1％（19／135）和23.0％（31／135）。经受试者工作特征曲线下面积（Az）法分析，1、2年血浆EBV DNA水平对分别判断1、2年复发转移率的准确性较高（Az1=0944，Az2=0925；P均＜0.05）。结论 血浆EBV DNA定量水平能够较好地反映局部晚期鼻咽癌放化疗综合治疗的近期疗效。对于治疗前血浆EBV DNA阳性的局部晚期鼻咽癌患者，综合治疗结束后2年内实时监测血浆EBV-DNA水平对判断复发转移有一定的临床价值。

Clinical significance of plasma epstein-barr virus DNA quantitative monitoring in the treatment and follow-up for locally advanced nasopharyngeal carcinoma

Objective To explore the clinical significance of plasma epstein-barr virus DNA （EBV-DNA） quantitative moni- toring in the treatment and follow-up for locally advanced nasopharyngeal carcinoma. Methods Plasma EBV-DNA levels of 156 locally advanced nasopharyngeal cancer patients were detected during concurrent radiochemotherapy with 0, ：2, 4, 6, 8 weeks, and plasma EBV-DNA levels of patients with who plasma EBV-DNA-positive before the treatment and followed up were detected after 6, 12, 18, 24 months, using quantitative PCR technique. The efficacy and recurrence and metastasis situation during two years after treatment were evaluated respectively. Results Plasma EBV-DNA-positive rate of 156 patients was 91.0% （142/156） before concurrent radio- chemotherapy, and positive rate of 9.6% （15/156） after 8 weeks of the treatment. One hundred and twenty-seven out of 142 plasma EBV-DNA-positive patients with pre-treatment, plasma EBV-DNA levels showed a trend of decline from the treatment of 2 weeks. On 6 weeks of the treatment, DNA replication were not detected in 127 patients. The other plasma EBV-DNA level of 15 cases maintained the positive level after 8 weeks of the treatment. One hundred and nineteen cases were complete response and 37 cases were partial re- sponse, of which the plasma EBV-DNA positive rate of 8 weeks after the treatment was 3.4% （4/119） and 29.7% （ 11/37）, respec- tively. 135 out of 142 patients with pre-treatment plasma EBV-DNA-positive were followed up for two years, 1-, 2-year recurrence rate was 14. 1% （19/135） and 23.0% （31/135）, respectively. By receiver operating characteristic curve analysis, 1-, 2-year plasma EBV-DNA levels were higher judged on accuracy of 1-, 2-year recurrence rate （Azl = 0. 944,Az2 = 0. 925 ; P〈 0. 05 ）. Conclusion Quantification of plasma EBV-DNA level can better reflect the efficacy of locally advanced nasopharyngeal carcinoma after comprehen-sire treatment. For pre-treatment plasma EBV-DNA-positive locally advanced nasopharyngeal ca