Elevated plasma fibrinogen level shows superior prognostic value than Epstein-Barr virus DNA load for stage IVA/B nasopharyngeal carcinoma patients in the intensity-modulated radiotherapy era.

Abstract

PURPOSE:

Effective prognostic factors for patients with stage IVA/B nasopharyngeal carcinoma (NPC) who are susceptible to distant metastases are limited. We aim to investigate the prognostic value of pretreatment plasma fibrinogen (FIB) level and Epstein-Barr virus DNA (EBV-DNA) load in these patients in the era of intensity-modulated radiotherapy (IMRT).

RESULTS:

The 5-year DSS, DFS and DMFS rates of the entire cohort were 72.7%, 66.8%, 80.0%, respectively. High FIB level was identified as a negative prognostic factor for survival: the 5-year DSS, DFS and DMFS rates for patients with high FIB (> 4.0 g/L) and normal FIB (≤ 4.0 g/L) were 60.3% vs. 76.0%, 56.0% vs. 69.9%, and 59.4% vs. 85.5%, respectively (all P < 0.001). Subgroup analysis demonstrated that DSS, DFS and DMFS decreased as FIB gradually increased, even within the normal range. The risk of distant metastasis in patients with high FIB was over 3-fold than patients with normal FIB. EBV-DNA was not an independent prognostic factor for any survival outcomes in multivariate analysis.

CONCLUSION:

High pretreatment FIB level shows superior prognostic value than EBV-DNA load for stage IVA/B NPC patients in the era of IMRT.

MATERIALS AND METHODS:

A total of 755 patients with newly-diagnosed stage IVA/B NPC treated with definitive IMRT between January 2007 and December 2011 were enrolled. Plasma FIB and EBV-DNA were measured before treatment. Disease-specific survival (DSS), disease-free survival (DFS) and distant metastasis-free survival (DMFS) were calculated using the Kaplan-Meier method; differences were compared using the log-rank test.

• Authors: Mei Lan, Chunyan Chen, Ying Huang, Minjie Mao, Fei Han, Junfang Liao, Meiling Deng, Zhijun Duan, Lie Zheng, Shaoxiong Wu, Taixiang Lu, Yutao Jian
• Journal: Oncotarget (Oncotarget) Vol. 7 Issue 29 Pg. 46242-46252 (Jul 19 2016) ISSN: 1949-2553 [Electronic] United States
• PMID: 27323828 (Publication Type: Journal Article)

Chemical References

• Biomarkers, Tumor
• DNA, Viral
• Fibrinogen

Topics

• Adult
• Aged
• Biomarkers, Tumor (blood)
• Carcinoma (blood, mortality, virology)
• DNA, Viral (analysis)
• Disease-Free Survival
• Epstein-Barr Virus Infections (complications)
• Female
• Fibrinogen (analysis)
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Nasopharyngeal Carcinoma
• Nasopharyngeal Neoplasms (blood, mortality, virology)
• Prognosis
• Radiotherapy, Intensity-Modulated