Study Of Clinical Staging Of Nasopharyngeal Carcinoma Based On IMRT And The Clinic Volue Of EB Virus MiRNA-BART7

Part I Impact of intensity-modulated radiotherapy on nasopharyngealcarcinoma: evaluation of the 7th edition AJCC staging systemBackground and purpose The purpose of this study was to evaluate the 7th editionUICC/AJCC staging system for nasopharyngeal carcinoma(NPC) patients who weretreated with intensity modulated radiation therapy(IMRT). Materials and methodsThe clinical data of 1241 NPC patients with initial magnetic resonance imaging(MRI)scan were studied retrospectively. All MRIs were reevaluated and restaged accordingto the 7th edition by 2 radiologists specializing in head and neck cancersindependently. Analysis of prognostic factors in local relapse-free survival(LRFS),distant metastasis-free survival(DMFS) and disease-specific survival(DSS) wereperformed. Results The differences of LRFS between T1 and T2, T2 and T3 were notsignificant(p = 0.055 and 0.605, respectively). Hazard ratios(HRs) for DSS betweenT2 and T3 or T3 and T4 differed significantly, but not between T1 and T2(P=0.070).For patients with T1-T3 disease, though skull base infiltration did not impact localfailure, it was an independent prognostic factor for both distant failure and cancerdeath. The survival of stage T3 with MRI-detected cranial nerve involvement(CNI)was superior to that of stage T4 and there was no statistically significant differencebetween T3 with and without MRI-detected CNI.The survival of stage III(with orwithout MRI-detected CNI) was significant superior to that of stage IV, and nostatistically significant difference was found between Stage III with and withoutMRI-detected CNI for all endpoints. The differences of DMFS between N0 and N1,N1 and N2 were significant. However no significant difference was found in DMFSbetween N2 and N3 a, N3 a and N3 b. Conclusion when treated with IMRT, theprognostic value of the N classification of the current staging system had not changedmuch. The difference of LRFS and DSS between T1 and T2 diminished, indicatingthat merging T2 to T1 is rational. The survival of stage T3/III patients with andwithout MRI detected CNI were similar, but significantly better than patients withstage T4/IV. The stage T3 with MRI-detected CNI NPC should not be classified asstage T4.Part II The clinic value of EB virus mi RNA-BART7 for nasopharyngealcarcinomaBackground and Purpose To assess the value of mi RNA-BART7 as biomarker forNPC, blood specimens from NPC patients and non-NPC individials were collected.EB virus-encoded mi RNA-BART7 were detected. Materials and methods Bloodsamples were obtained from NPC patients(n=91), non-NPC tumor patient controls(n=17) and healthy(n=28). Blood specimens after completion of radiotherapy werealso colected from 41 newly diagnosoed NPC patients. Quantitative PCR assay wereused to evaluate the expression level of plasma mi RNA-BART7. Correlation analysiswere conducted between the level of mi RNA-BART7 and clinical information such asclinical stage, tumor size, treatment factors, etc. Plasma EBV DNA and serum EBVVCA-Ig A, EA- Ig A, Rta-Ig G concentration were analysised simultaneously tocompare the value of mi RNA-BART7 for NPC diagnosis, treatment evaluation andpronosis. Results Plasma mi RNA-BART7 were significantly higher among NPCpatients than non-NPC tumors patients and healthy controls. ROC curve shows thatthe diagnostic accuracy rate of mi RNA-BART7 for NPC was 0.912(95% CI:0.863-0.962). The expression level of plasma mi RNA-BART7 before treatment wascorrelated with T classification, N classification, clinical stage and tumor volume. Thegreater of tumor volume and more advanced tumor stage, the higher level ofmi RNA-BART7 were dectected. Plasma mi RNA-BART7 in NPC patients presentedwith a higher positive rate than EBV DNA(95.5% vs. 51.3%). The high level ofmi RNA-BART7 were diminished after treatment, while EBV related antibodyconcentration has not changed regularly. Conclusion Plasma mi RNA-BART7 showedhigh accuracy for diagonse of NPC. The pretreatment level of mi RNA-BART7 wasclosely related to clinical stage and tumor volume, furthermore, it decreased aftertreatment. These results indicated that mi RNA-BART7 was a promising biomarkersfor NPC.