EB病毒DNA和鼻咽癌治疗预后之相关联性培训课件.ppt

1、EBEB病毒病毒DNADNA和鼻咽癌和鼻咽癌治疗预后之相关联性治疗预后之相关联性 Introduction of nasopharynx Introduction of nasopharyngeal carcinoma(NPC)Related articles of EBV DNA and NPC prognosis -EBV DNA level and NPC recurrence -EBV DNA level and distant metastasis -EBV DNA level and survival -EBV DNA level and treatment response 2E

2、B病毒DNA和鼻咽癌治疗预后之相关联性 The nasopharynx(nasal part of the pharynx)is the uppermost part of the pharynx It extends from the base of the skull to the upper surface of the soft palate Nasopharynx3EB病毒DNA和鼻咽癌治疗预后之相关联性Nasopharynx4EB病毒DNA和鼻咽癌治疗预后之相关联性Examination of Nasopharynx5EB病毒DNA和鼻咽癌治疗预后之相关联性6EB病毒DNA和鼻咽癌

3、治疗预后之相关联性Nasopharyngoscope7EB病毒DNA和鼻咽癌治疗预后之相关联性Fossa of Rosenmuller8EB病毒DNA和鼻咽癌治疗预后之相关联性Nasopharyngeal Carcinoma(NPC)Epidemiology-Epidemiology-Common in southern regions of China,Common in southern regions of China,particularly in Guangdong,Fujian,particularly in Guangdong,Fujian,Hong-kong and Taiwa

4、n Hong-kong and Taiwan 150 cases per 100,000 people in 150 cases per 100,000 people in Guangdong,7.7 cases per 100,000 Guangdong,7.7 cases per 100,000 people in Taiwan,and 0.11.7 per people in Taiwan,and 0.11.7 per 100,000 people in USA100,000 people in USA NPC is seen primarily in middle-NPC is see

5、n primarily in middle-aged(4555 y/o)persons in Asia,a aged(4555 y/o)persons in Asia,a high proportion of African cases high proportion of African cases appear in childrenappear in children9EB病毒DNA和鼻咽癌治疗预后之相关联性 Etiology-Etiology-Cause?Not clearCause?Not clear EB virus-related to EB virus-related to u

6、ndifferentiated typeundifferentiated type Gene-(HLA-A2,Aw19,BSin 2,B17,Gene-(HLA-A2,Aw19,BSin 2,B17,BW16)BW16)Diet (salted vegetables,fish and Diet (salted vegetables,fish and meat-dimethylnitrosamines)meat-dimethylnitrosamines)Environment smoking,nickel Environment smoking,nickel exposure,formaldeh

7、yde(exposure,formaldehyde(甲醛甲醛)Nasopharyngeal Carcinoma(NPC)10EB病毒DNA和鼻咽癌治疗预后之相关联性11EB病毒DNA和鼻咽癌治疗预后之相关联性Symptoms and Signs Neck mass Ear fullness and hearing impairment (middle ear effusion)Blood tingled sputum Nasal obstruction Headache Diplopia12EB病毒DNA和鼻咽癌治疗预后之相关联性Diagnosis and Treatment 13EB病毒DN

8、A和鼻咽癌治疗预后之相关联性Related Articles of Related Articles of EBV DNA and NPC prognosis EBV DNA and NPC prognosis 14EB病毒DNA和鼻咽癌治疗预后之相关联性EBV DNA level and NPC recurrence15EB病毒DNA和鼻咽癌治疗预后之相关联性EBV DNA level and NPC recurrence Plasma/serum cell-free EBV DNA may be a valuable tool for the monitor of NPC patients

9、 for the early detection of tumor recurrence Lo YM.et al.Cancer Res.1999 Circulating EBV DNA has been found not only to correlate with disease staging,but also to provide useful information for the monitoring for tumor recurrence Lo YM.et al.Biomed Pharmacother.2001.Review The failure of complete an

10、d rapid elimination of EBV DNA from the circulation predicts disease recurrence To EW.et al.Clin Cancer Res.200316EB病毒DNA和鼻咽癌治疗预后之相关联性 This study provide convincing evidence for the use of plasma EBV DNA measurements for the early diagnosis and staging of NPC a well as for monitoring recurrence and

11、metastasis of this tumor Shao JY.et al.Cancer.2004 The usefulness of EBV DNA as a useful tool in monitoring NPC by its ability to detect early recurrence and excellent correlation with treatment response Chan SL et al.BMC Cancer.2006 The plasma EBV DNA assay correctly predicted all NPC recurrences,a

12、nd PET had high capacity to localize potential lesion sites Wang WY et al.Cancer.2011EBV DNA level and NPC recurrence17EB病毒DNA和鼻咽癌治疗预后之相关联性 The risks of loco-regional failure were not significantly different between patients with high and those with low EBV DNA levels Leung SF.et al.Cancer.2003 Plas

13、ma EBV DNA load measurement appears to be useful in a low tumor risk area(western Europe).However,development of local recurrences may not always coincide with raised level of EBV DNA Kalpoe JS.et al.J Clin Pathol.2006 EBV DNA level and NPC recurrence18EB病毒DNA和鼻咽癌治疗预后之相关联性Conclusion-NPC recurrence w

14、as highly related to EBV DNA level,but not always coincidedWith an asymptomatic rise in the plasma EBV DNA level,tumor recurrence should be consideredEBV DNA level and NPC recurrence19EB病毒DNA和鼻咽癌治疗预后之相关联性EBV DNA level and distant metastasis 20EB病毒DNA和鼻咽癌治疗预后之相关联性EBV DNA level and distant metastasis

15、Patients with distant failure had significantly higher pre-therapy EBV DNA levels than those without failure Leung SF.et al.Cancer 2003Kaplan Meier plot of freedom from distant failure for patient subgroups with high versus low pretherapy Epstein Barr virus(EBV)DNA levels21EB病毒DNA和鼻咽癌治疗预后之相关联性Conclu

16、sion-EBV DNA level was highly related to distant metastasisClose monitoring EBV DNA level could early detect distant failure in NPC patientsEBV DNA level and distant metastasis 23EB病毒DNA和鼻咽癌治疗预后之相关联性EBV DNA level and survival24EB病毒DNA和鼻咽癌治疗预后之相关联性 Levels of post-treatment plasma EBV DNA in patients

17、with NPC appear to strongly predict progression-free and overall survival and to accurately reflect the post-treatment residual tumor load Chan AT.et al.J Natl Cancer inst.2002 Pre-therapy circulating EBV DNA load is an independent prognostic factor for overall survival in NPC Leung SF.et al.J Clin

18、Oncol.2006EBV DNA level and survival25EB病毒DNA和鼻咽癌治疗预后之相关联性 Survival probabilities of patient groups according to Epstein-Barr virus(EBV)DNA levels.Low DNA denotes low EBV DNA levels of less than 4000 copies/ml,and high DNA denotes high EBV DNA levels of 4000 copies/ml Leung SF.et al.J Clin Oncol.200

19、626EB病毒DNA和鼻咽癌治疗预后之相关联性 EBV DNA status remains a strong predictor for overall survival in NPC Kenneth WY.et al.Clin Cancer Res.2006 Metastatic/recurrent NPC patients with low pre-treatment plasma EBV DNA level and undetectable post-treatment plasma EBV DNA showed a favorable prognosis and survival A

20、n X.et al.Cancer.2011EBV DNA level and survival27EB病毒DNA和鼻咽癌治疗预后之相关联性 The 5-year overall survival rate in low pre-treatment plasma EBV DNA level and undetectable post-treatment plasma EBV DNA subgroup was 50.6%.However,no patients in the other 3 subgroups survived 5 years An X.et al.Cancer.201128EB病

21、毒DNA和鼻咽癌治疗预后之相关联性Conclusion-EBV DNA level was highly related to survival rateLower pre-treatment plasma EBV DNA level and undetectable post-treatment plasma EBV DNA showed the best prognosisEBV DNA level and survival29EB病毒DNA和鼻咽癌治疗预后之相关联性EBV DNA level and treatment response30EB病毒DNA和鼻咽癌治疗预后之相关联性EBV

22、DNA level and treatment response Rapid clearance of plasma Epstein-Barr virus DNA after surgical treatment of nasopharyngeal carcinoma To EW.et al.Clin Caner Res.2003 The in vivo elimination of EBV DNA is very rapid after surgical resection of NPC The failure of complete and rapid elimination of EBV

23、 DNA from the circulation predicts disease recurrence 31EB病毒DNA和鼻咽癌治疗预后之相关联性 Plasma EBV DNA clearance rate as a novel prognostic marker for metastatic/recurrent nasopharyngeal carcinoma Wang WY.et al.Clin Cancer Res.2010 Patients with a short t1/2 of plasma EBV DNA clearance have significantly highe

24、r complete response rate and overall survival than those with long t1/2 The plasma EBV DNA concentrations have no significant effects on outcome predictionEBV DNA level and treatment response32EB病毒DNA和鼻咽癌治疗预后之相关联性33EB病毒DNA和鼻咽癌治疗预后之相关联性34EB病毒DNA和鼻咽癌治疗预后之相关联性 The plasma EBV DNA concentrations have no

25、significant effects on outcome prediction The t1/2 of plasma EBV DNA clearance shows significant effects on tumor response 35EB病毒DNA和鼻咽癌治疗预后之相关联性 The clearance rates of plasma EBV DNA during the first month of chemotherapy can predict tumor response and patient survival Early change of chemotherapy

26、regimen may be considered for patients with slow plasma EBV DNA clearance rate Wang WY.et al.Clin Cancer Res.2010EBV DNA level and treatment response36EB病毒DNA和鼻咽癌治疗预后之相关联性Conclusion-EBV DNA level was a useful tool to monitor tumor response after therapyThe clearance rates of plasma EBV DNA seemed be

27、tter than the concentration of plasma EBV DNA in predicting tumor responseEBV DNA level and treatment response37EB病毒DNA和鼻咽癌治疗预后之相关联性Conclusion EBV DNA level was a useful tool in monitoring tumor recurrence,distant metastasis,survival and treatment response in nasopharyngeal carcinoma38EB病毒DNA和鼻咽癌治疗预后之相关联性39EB病毒DNA和鼻咽癌治疗预后之相关联性