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通过分析血浆EB病毒DNA筛查鼻咽癌
Analysis of Plasma Epstein–Barr Virus DNA to Screen for Nasopharyngeal Cancer


K.C. Allen Chan ... 肿瘤 • 2017.08.10
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• 通过分析血浆EB病毒DNA筛查鼻咽癌 

鼻咽癌人群筛查新利器——EBV DNA

 

黎扬婵,孙颖*

中山大学肿瘤防治中心放疗科

*通讯作者

 

癌症的早发现、早诊断是疾病二级预防的重要内容。2017年8月10日发表在《新英格兰医学杂志》的一篇关于利用游离循环EBV DNA进行鼻咽癌筛查的研究阐明了其可行性1。该前瞻性队列研究来自中国香港特区,在20,174名参与者中,有1,112名(5.5%)参与者EBV DNA阳性,而其中309名为持续阳性。有300名持续阳性的患者接受了进一步检查,包括鼻内镜或MRI,34名证实为鼻咽癌患者。未接受进一步检查的9名参与者中,其中1名32个月后发展为晚期鼻咽癌。其余EBV DNA检测为阴性的参与者中,1年内仅有1名发展为鼻咽癌。因此,采用游离循环EBV DNA进行鼻咽癌的筛查,敏感性可达97.1%,特异性为98.6%。

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摘要


背景

循环游离EB病毒(EBV)DNA是鼻咽癌的一种生物标志物。我们在无症状的人群中开展了一项前瞻性研究,目的是探讨血浆样本中EBV DNA是否有助于筛查早期鼻咽癌。

 

方法

在没有鼻咽癌症状的参与者中,我们分析血浆中的EBV DNA。初次检测结果阳性的参与者在约4周后再次接受检测,血浆EBV DNA持续阳性的参与者接受鼻内镜和磁共振成像(MRI)检查。

 

结果

共计20,174例参与者经历了筛查。从1,112例参与者(5.5%)的血浆标本可检出EBV DNA,其中309例参与者(占全部参与者的1.5%,占初次检测阳性参与者的27.8%)的重复检测标本呈现持续阳性结果。在这309例参与者中,300例接受了内镜检查,275例接受了内镜和MRI两项检查;在这些参与者中,34例罹患鼻咽癌。通过筛查发现的鼻咽癌患者中,Ⅰ期或Ⅱ期鼻咽癌的比例显著高于历史队列(71% vs. 20%,卡方检验P<0.001),而且3年无进展生存率亦显著高于历史队列(97% vs. 70%;风险比0.10;95%置信区间[CI],0.05~0.18)。9例参与者拒绝接受进一步检查,其中1例在入组后32个月出现晚期鼻咽癌症状。血浆EBV DNA检测为阴性的参与者中,在检测后1年内仅有1例发生鼻咽癌。通过血浆EBV DNA筛查鼻咽癌的敏感性和特异性分别是97.1%和98.6%。

 

结论

分析血浆中的EBV DNA有助于筛查早期、无症状鼻咽癌。与一个历史队列相比,通过筛查发现的鼻咽癌患者,病期显著较早,而且结局较好(由嘉道理慈善基金会[Kadoorie Charitable Foundation]和中国香港特区政府研究资助局资助;在ClinicalTrials.gov注册号为NCT02063399)。





作者信息

K.C. Allen Chan, F.R.C.P.A., John K.S. Woo, F.R.C.S., Ann King, F.R.C.R., Benny C.Y. Zee, Ph.D., W.K. Jacky Lam, F.R.C.S., Stephen L. Chan, F.R.C.P., Sam W.I. Chu, B.Sc., Constance Mak, B.S.N., Irene O.L. Tse, B.N., Samantha Y.M. Leung, B.N., Gloria Chan, R.N., Edwin P. Hui, F.R.C.P., Brigette B.Y. Ma, M.D., Rossa W.K. Chiu, F.R.C.P.A., Sing-Fai Leung, F.R.C.R., Andrew C. van Hasselt, F.R.C.S., Anthony T.C. Chan, F.R.C.P., and Y.M. Dennis Lo, F.R.S.
From the Li Ka Shing Institute of Health Sciences (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), the Department of Chemical Pathology (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), State Key Laboratory of Oncology in South China, Sir Y.K. Pao Centre for Cancer (K.C.A.C., W.K.J.L., S.L.C., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., E.P.H., B.B.Y.M., R.W.K.C., S.-F.L., A.T.C.C., Y.M.D.L.), Department of Otorhinolaryngology, Head and Neck Surgery (J.K.S.W., W.K.J.L., A.C.H.), Department of Imaging and Interventional Radiology (A.K.), Jockey Club School of Public Health and Primary Care (B.C.Y.Z.), and Department of Clinical Oncology (S.L.C., E.P.H., B.B.Y.M., S.-F.L., A.T.C.C.), Chinese University of Hong Kong, Prince of Wales Hospital — all in Hong Kong. Address reprint requests to Dr. K.C. Allen Chan or Dr. Lo at the Department of Chemical Pathology, Chinese University of Hong Kong, Prince of Wales Hospital, 30–32 Ngan Shing St., Shatin, Hong Kong, or at allen@cuhk.edu.hk or loym@cuhk.edu.hk. Sing-Fai Leung, F.R.C.R., is deceased.

 

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