Influence of blood EBV-DNA level on survival of patients with nasopharyngeal cancer on immune checkpoint inhibitors: a meta-analysis.

IF 3.2 2区医学 Q3 IMMUNOLOGY

Infectious Agents and Cancer Pub Date : 2025-12-03 DOI:10.1186/s13027-025-00718-3

Yanbing Li, Lingyu Cai, Hongbo Zuo

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引用次数: 0

Abstract

OBJECTIVES: Pretreatment plasma Epstein–Barr virus (EBV) DNA is a promising biomarker in nasopharyngeal cancer (NPC). However, its prognostic significance in patients receiving immune checkpoint inhibitors (ICIs) remains unclear. This meta-analysis evaluated the association between pretreatment EBV-DNA levels and survival outcomes in NPC patients treated with ICIs. METHODS: PubMed, Embase, and Web of Science were searched up to June 29, 2025. Eligible longitudinal studies included adult NPC patients treated with ICIs, with pretreatment EBV-DNA assessed by quantitative PCR and survival outcomes reported as hazard ratios (HRs). Pooled analyses used random-effects models accounting for the potential influence of heterogeneity. RESULTS: Thirteen cohorts from 12 studies, comprising 1,507 patients, were included. Most cohorts were prospective; two were retrospective. Overall, high pretreatment EBV-DNA was significantly associated with poorer progression-free survival (PFS; HR = 1.72, 95% CI: 1.46 to 2.03, p < 0.001; I² = 0%) and overall survival (OS; HR = 2.03, 95% CI: 1.50 to 2.77, p < 0.001; I² = 18%). Sensitivity analyses by excluding one study at a time showed similar results. Subgroup analyses for the outcome of PFS showed consistent associations across study design (prospective vs. retrospective), treatment line (first vs. later), concurrent therapy, cutoff thresholds (< 7,800 vs. ≥ 7,800 copies/mL), follow-up duration, analytic model, and study quality (all p for subgroup differences > 0.05). CONCLUSIONS: High pretreatment EBV-DNA levels predict significantly worse PFS and OS in NPC patients receiving ICIs. Pretreatment EBV-DNA may serve as a practical biomarker for risk stratification and treatment decision-making in this population. CLINICAL TRIAL NUMBER: Not applicable.

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血液EBV-DNA水平对使用免疫检查点抑制剂鼻咽癌患者生存的影响：一项荟萃分析

目的：预处理血浆eb病毒（EBV） DNA是一种有前景的鼻咽癌（NPC）生物标志物。然而，其在接受免疫检查点抑制剂（ICIs）治疗的患者中的预后意义尚不清楚。本荟萃分析评估了前处理EBV-DNA水平与接受ICIs治疗的鼻咽癌患者生存结果之间的关系。方法：检索截至2025年6月29日的PubMed、Embase和Web of Science。符合条件的纵向研究包括接受ICIs治疗的成年鼻咽癌患者，通过定量PCR评估预处理EBV-DNA，并以风险比（hr）报告生存结果。合并分析使用随机效应模型来考虑异质性的潜在影响。结果：纳入了来自12项研究的13个队列，包括1,507例患者。大多数队列是前瞻性的；两个是回顾性的。总体而言，高预处理EBV-DNA与较差的无进展生存期显著相关（PFS; HR = 1.72, 95% CI: 1.46至2.03,p 0.05）。结论：高EBV-DNA预处理水平可显著预测鼻咽癌患者接受ICIs治疗后的PFS和OS恶化。预处理EBV-DNA可作为该人群风险分层和治疗决策的实用生物标志物。临床试验编号：不适用。

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来源期刊

Infectious Agents and Cancer ONCOLOGY-IMMUNOLOGY

CiteScore

5.80

自引率

2.70%

发文量

期刊介绍： Infectious Agents and Cancer is an open access, peer-reviewed online journal that encompasses all aspects of basic, clinical, epidemiological and translational research providing an insight into the association between chronic infections and cancer. The journal welcomes submissions in the pathogen-related cancer areas and other related topics, in particular: • HPV and anogenital cancers, as well as head and neck cancers; • EBV and Burkitt lymphoma; • HCV/HBV and hepatocellular carcinoma as well as lymphoproliferative diseases; • HHV8 and Kaposi sarcoma; • HTLV and leukemia; • Cancers in Low- and Middle-income countries. The link between infection and cancer has become well established over the past 50 years, and infection-associated cancer contribute up to 16% of cancers in developed countries and 33% in less developed countries. Preventive vaccines have been developed for only two cancer-causing viruses, highlighting both the opportunity to prevent infection-associated cancers by vaccination and the gaps that remain before vaccines can be developed for other cancer-causing agents. These gaps are due to incomplete understanding of the basic biology, natural history, epidemiology of many of the pathogens that cause cancer, the mechanisms they exploit to cause cancer, and how to interrupt progression to cancer in human populations. Early diagnosis or identification of lesions at high risk of progression represent the current most critical research area of the field supported by recent advances in genomics and proteomics technologies.