全身性炎症介导转移性鼻咽癌中血浆EB病毒DNA与死亡率之间的关联
Systemic Inflammation Mediates the Association Between Plasma Epstein-Barr Virus DNA and Mortality in Metastatic Nasopharyngeal Carcinoma.
文献信息
| PMID | 42834566 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Qin Liu |
| 作者单位 | State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China. |
| 期刊 | International journal of cancer |
| SCI 分区 | Q2 |
| IF | 5.8 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻咽癌 |
中文摘要
我们旨在全面评估一系列广泛的全身性炎症相关生物标志物与转移性鼻咽癌（mNPC）总生存期（OS）之间的关联，并评估这些特征是否介导高EBV DNA负荷对长期结局的不良影响。本研究纳入了2016年至2022年间在中山大学肿瘤防治中心接受治疗的1847例mNPC患者。采用多变量Cox比例风险模型、限制性立方样条（RCS）模型和时间依赖性受试者工作特征（ROC）曲线分析来评估炎症相关指标与OS的关联。探索性中介分析量化了生物标志物部分介导血浆EBV DNA负荷与死亡风险之间关联的程度。平均随访时间为45.4个月；发生713例（38.6%）死亡。血浆EBV DNA显示出稳定的区分能力（1年、3年和5年OS的AUC分别为0.63、0.62和0.61）。完全调整后，CALLY和LCR具有保护性，而CAR、NAR、SIRI、IBI、MLR、NC、PC、GPS、mGPS和LCS为不良因素。CAR、CALLY、LCR、IBI和NC显示出最高的区分能力（1年AUC为0.65-0.66）。中介分析表明，MLR、SIRI、CALLY和NC解释了EBV DNA负荷-死亡率关联的7.6%-9.6%。在mNPC中，治疗前EBV DNA升高与协调的全身性炎症特征和更差的OS相关。选定的炎症标志物在统计学上解释了EBV DNA负荷与死亡率之间观察到的关联中的一小部分。将EBV DNA与炎症特征相结合可能改善风险分层，并指导强化监测、早期评估和风险适应性治疗。
英文摘要
We aimed to comprehensively evaluate the associations of a broad panel of systemic inflammation-related biomarkers with overall survival (OS) in metastatic nasopharyngeal carcinoma (mNPC) and to assess whether these signatures mediate the adverse impact of high EBV DNA burden on long-term outcomes. This study included 1847 patients with mNPC treated at Sun Yat-sen University Cancer Center between 2016 and 2022. Multivariable Cox proportional hazards models, restricted cubic spline (RCS) models, and time-dependent receiver operating characteristic (ROC) curve analyses were used to evaluate associations of inflammation-related indices with OS. Exploratory mediation analyses quantified the extent to which biomarkers partially mediated the association between plasma EBV DNA burden and mortality risk. Mean follow-up was 45.4 months; 713 (38.6%) deaths occurred. Plasma EBV DNA showed stable discrimination (AUCs of 0.63, 0.62, and 0.61 for 1-, 3-, and 5-year OS). After full adjustment, CALLY and LCR were protective, whereas CAR, NAR, SIRI, IBI, MLR, NC, PC, GPS, mGPS, and LCS were adverse. CAR, CALLY, LCR, IBI, and NC showed the highest discrimination (1-year AUCs, 0.65-0.66). Mediation analyses indicated that MLR, SIRI, CALLY, and NC accounted for 7.6%-9.6% of the EBV DNA load-mortality association. Elevated pretreatment EBV DNA was associated with a coordinated systemic inflammatory profile and worse OS in mNPC. Selected inflammatory markers statistically accounted for a modest proportion of the observed association between EBV DNA burden and mortality. Integrating EBV DNA with inflammatory profiles may improve risk stratification and guide intensified surveillance, earlier assessment, and risk-adapted therapy.