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Objective:To investigate the value of plasma Epstein-Barr virus (EBV) DNA detection in the screening of nasopharyngeal carcinoma (NPC) and its clinical application in non-high-risk areas.Methods:Plasma EBV DNA results in 1 153 newly diagnosed nasopharyngeal carcinoma patients who were treated in Sichuan Cancer Hospital from 2015 to 2020 and 244 healthy control cases with matched sex and age were retrospectively analyzed. EBV DNA were detected by quantitative real-time PCR. Positive rate of EBV DNA was determined by the cutoff value of 400 (≥400 copies/ml as positive) and optimization threshold method (presence of S amplification curve as positive). Further analyses were conducted to compare EBV DNA load in different clinical stage, TNM stage and regions distribution characteristics. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic value of the cutoff value of 400 and optimization threshold method for NPC.Results:Compared with healthy controls, EBV DNA increased significantly in newly diagnosed NPC patients ( P<0.001). Both evaluation methods revealed that the EBV DNA positive percentage increased with TNM and clinical stage ( P<0.001). With 400 copies/ml as cutoff value, the diagnostic sensitivity and specificity were 40.85% and 100%, respectively. The area under the curve was 0.704 (95% CI 0.676-0.733, P<0.001). Evaluated by the optimization threshold method, the sensitivity and specificity could improve to 82.0% and 99.2%, respectively, and the area under the curve reached 0.910 (95% CI 0.894-0.924, P<0.001). Conclusions:In the low prevalence area of nasopharyngeal carcinoma, the sensitivity for diagnosis of nasopharyngeal carcinoma is only 40.9% by the 400 copies/ml cutoff value method. The optimization threshold method is a better choice to improve the diagnostic sensitivity without lowering the diagnostic specificity.
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Nasopharyngeal carcinoma (NPC) is a common head and neck malignant tumor with high incidence in southern China. Local recurrence is one of the main failure modes of locally advanced NPC. The dose-escalation after radical radiotherapy for locally advanced NPC remains controversial. In the era of modern radiotherapy, the mainstream treatment mode of locally advanced NPC is neoadjuvant chemotherapy plus concurrent chemoradiotherapy. There is no consensus on whether to prescribe dose-escalation, how and when to conduct dose-escalation, how much dose to prescribe for patients with residual lesion proved by MRI or pathology. How to accurately determine the target volume and dose / fraction to maximize the local control of the tumor are the directions of clinical practice for locally advanced NPC, which remain to be further studied.
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Objective To explore the methods for solving the neck two-point T2-DIXON fat-water separation misalignment. Methods During August 2015 to July 2016, 140 patients with fat-water separation on the nasopharynx and cervical axial T2-DIXON images were prospectively recruited from Sichuan Cancer Hospital. There was no metal implant in the fat-water separation misalignment area. The patients were divided into 7 groups by random number table method with 20 patients in each group for the axial T2-DIXON scan: Group A adopted plan 1( increasing localized shim box on the fat-water separation misalignment area);Group B adopted plan 2(increasing the times of repeated acquisition to 2 of the T2-DIXON sequence);Group C adopted plan 3 (placing the shimming assist device on the inspection area);Group D adopted plan 1+plan 2;Group E adopted plan 1+plan 3;Group F adopted plan 2+plan 3;Group G adopted plan 1+plan 2+plan 3. The images quality of two scans were graded and compared. We compared the signal-to-noise ratio (SNR) of T2-DIXON image on the same muscle tissue between the two scans of each group. The difference of SNR on the two scan images was compared with the paired t test, the difference of SNR among seven groups was conducted with independent sample t test, and the comparison of image quality classification was conducted by rank sum test. Results The image quality of all the seven groups was improved to some different degrees. The cases with image quality reaching level 3 were 12, 15, 15, 16, 17, 18 and 18 in A to G groups, respectively. It was better to use the combination of two or more methods to improve the quality of the image than to use a single method. There were no statistically significant differences in SNR between two scans in A, C and E group (all P>0.05).There were statistically significant differences in SNR between two scans in groups of B, D, F and G(all P<0.05). There were statistically significant differences among the 7 groups, with the best quality in G group (P<0.05). There was no significant difference in the first SNR among the 7 groups (P>0.05);there were significant differences in the second scans among the 7 groups (P<0.05) .Conclusions This study suggests that placing localized shim box, increasing the times of repeated acquisition, and use of shimming assist device in MRI correct the fat-water separation misalignment, help to provide images with high quality. The combination of the above method was better than using the single method. The SNR can be improved when increasing the times of repeated acquisition.
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Objective To explore the association between prognostic nutritional index(PNI) and prognosis of nasopharyngeal carcinoma (NPC) patients before radiochemotherapy.Methods A total of 153 newly diagnosed NPC patients in Sichuan Cancer Hospital were retrospectively reviewed.The hematological parameters and clinical characteristics before radiochemotherapy were collected,and the follow up for these patients was conducted.The effects of pretreatment hematological parameters and PNI on overall survival were analyzed with Kaplan-Meier method.The variables identified as statistically significant differences were further analyzed with multivariate Cox regression analysis.Results The 3,5 and 10-year overall survival were 89.54％,83％ and 75.16％.Both PNI and white blood cell count (WBC) before radiochemotherapy were the independent prognostic indicators for NPC in Cox regression analysis.The 3,5 and 10-year overall survival of NPC in PNI ≤49.45 group were lower than those of PNI ＞ 49.45 group.Conclusion PNI and WBC should be the independent prognostic indicators for NPC and closely relate to overall survival of NPC patients.
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Objective To investigate the clinical therapeutic effect of comprehensive treatment in young women with cervical car-cinoma.Methods A total of 52 young women with cervical carcinoma were treated with uterine artery chemoembolization.50 cases underwent radical hysterectomy and pelvic lymphadenectomy after interventional therapy.The patients with pathological risk factors were given supplementary radiotherapy.Results The clinical overall response rate was 88.5%.96.2% of patients underwent sur-gery and lymph node metastasis rate was 26.9%.The 2,5 year overall survival rates of patients were 91.5%,71.2% respectively. Conclusion The comprehensive treatment can improve overall survival rate and quality of life for young woman with cervical carci-noma.Postoperative patients with pathologically related risk factors should be treated with supplement chemoradiotherapy.