Evaluation of plasma Epstein-Barr virus DNA load to distinguish nasopharyngeal carcinoma patients from healthy high-risk populations in Southern China

Authors

  • Ming-Fang Ji MD,

    1. Cancer Research Institute of Zhongshan City, Zhongshan City, Guangdong Province, China
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  • Qi-Hong Huang MD,

    1. Sihui Cancer Institute, Sihui, Guangdong Province, China
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  • Xia Yu MD,

    1. Cancer Research Institute of Zhongshan City, Zhongshan City, Guangdong Province, China
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  • Zhiwei Liu MD,

    1. Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
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  • Xinghua Li MD,

    1. Cancer Research Institute of Zhongshan City, Zhongshan City, Guangdong Province, China
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  • Li-Fang Zhang MD,

    1. Department of Cancer Prevention Research, Cancer Prevention Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong Province, China
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  • Panpan Wang MD,

    1. Cancer Research Institute of Zhongshan City, Zhongshan City, Guangdong Province, China
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  • Shang-Hang Xie MPH,

    1. Department of Cancer Prevention Research, Cancer Prevention Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong Province, China
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  • Hui-Lan Rao MD, PhD,

    1. Department of Pathology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong Province, China
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  • Fang Fang MD, PhD,

    1. Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
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  • Xiang Guo MD, PhD,

    1. Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong Province, China
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  • Qing Liu PhD,

    1. Department of Cancer Prevention Research, Cancer Prevention Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong Province, China
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  • Ming-Huang Hong MD,

    1. Clinical Trail Study Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong Province, China
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  • Weimin Ye MD, PhD,

    1. Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
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  • Yi-Xin Zeng MD, PhD,

    1. Department of Experimental Research, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong Province, China
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  • Su-Mei Cao MD, PhD

    Corresponding author
    1. Department of Cancer Prevention Research, Cancer Prevention Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong Province, China
    • Corresponding author: Su-Mei Cao, MD, PhD, Department of Cancer Prevention Research, Sun Yat-sen University Cancer Center, 510060, 651 Dongfeng Road East, Guangzhou, P. R. China; Fax: (011) 86-20-87345685; caosm@sysucc.org.cn

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  • We appreciate the staff at Sihui Cancer Institute and Cancer Research Institute of Zhongshan City for their efforts in data linkage and follow-up.

Abstract

BACKGROUND

The utility of circulating Epstein-Barr Virus (EBV) DNA as a tumor marker for nasopharyngeal carcinoma (NPC) detection suggests that it might improve the diagnostic performance of anti-EBV antibody markers in NPC screening. In this study, the authors evaluated whether circulating EBV DNA load is capable of distinguishing NPC patients from high-risk individuals who have positive anti-EBV antibodies.

METHODS

In a population-based NPC screening trial in Sihui City and Zhongshan City, Guangdong Province, China, the authors previously identified 862 high-risk participants with 2 screening markers, immunoglobulin A (IgA) antibodies to EBV capsid antigen (VCA/IgA) and nuclear antigen-1 (EBNA1/IgA). In the current study, real-time polymerase chain reaction was used to measure the baseline plasma EBV DNA load among 825 participants (97%). Follow-up was extended to the end of 2011 to evaluate the diagnostic and predictive values of plasma EBV DNA load.

RESULTS

By using 0 copies/mL as the cutoff value, plasma EBV DNA had a sensitivity of 86.8% (33 of 38 patients) for NPC detected within the first year of follow-up, yielding a positive predictive value of 30% (33 of 110 participants) and a negative predictive value of 99.3% (696 of 701 participants). The patients who had early stage NPC had lower sensitivity (81.5%; 22 of 27 patients) than those who had advanced NPC (100%; 11 of 11 patients). For the 14 patients who had NPC detected after 1 year of follow-up, only 50% (7 of 14 patients) tested positive for EBV DNA at baseline.

CONCLUSIONS

The plasma EBV DNA load may improve the accuracy of diagnosing NPC in high-risk individuals, but it appears to have limited value in screening patients who have early stage NPC and predicting NPC development. Cancer 2014;120:1353–1360. © 2014 American Cancer Society.

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