Performance and Operational Feasibility of Epstein-Barr Virus-Based Screening for Detection of Nasopharyngeal Carcinoma: Direct Comparison of Two Alternative Approaches.

Autor:	Lou PJ; Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan., Jacky Lam WK; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.; Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.; State Key Laboratory of Translational Oncology, Sir Y.K. Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong SAR, China.; Centre for Novostics, Hong Kong Science Park, Pak Shek Kok, Hong Kong SAR, China., Hsu WL; Data Science Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.; Master Program of Big Data Analysis in Biomedicine, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan., Pfeiffer RM; Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD., Yu KJ; Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD., Chan CML; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.; Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China., Lee VCT; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.; Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China., Chen TC; Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan., Terng SD; Division of Head and Neck Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan., Tsou YA; Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan., Leu YS; Department of Otolaryngology, MacKay Memorial Hospital, Taipei, Taiwan., Liao LJ; Department of Otolaryngology, Far Eastern Memorial Hospital, New Taipei City, Taiwan., Chang YL; Department of Otolaryngology, Cathay General Hospital, Taipei, Taiwan., Chien YC; Genomics Research Center, Academia Sinica, Taipei, Taiwan., Wang CP; Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan., Lin CY; Division of Head and Neck Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan., Hua CH; Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan., Lee JC; Department of Otolaryngology, MacKay Memorial Hospital, Taipei, Taiwan., Yang TL; Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan., Hsiao CH; Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan., Wu MS; Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan., Tsai MH; Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan., Cheng HC; Division of Head and Neck Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan., Hildesheim A; Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD., Chen CJ; Genomics Research Center, Academia Sinica, Taipei, Taiwan., Chan KCA; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.; Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.; State Key Laboratory of Translational Oncology, Sir Y.K. Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong SAR, China.; Centre for Novostics, Hong Kong Science Park, Pak Shek Kok, Hong Kong SAR, China., Liu Z; Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.
Jazyk:	angličtina
Zdroj:	Journal of clinical oncology : official journal of the American Society of Clinical Oncology [J Clin Oncol] 2023 Sep 10; Vol. 41 (26), pp. 4257-4266. Date of Electronic Publication: 2023 Jul 21.
DOI:	10.1200/JCO.22.01979
Abstrakt:	Purpose: Two Epstein-Barr virus (EBV)-based testing approaches have shown promise for early detection of nasopharyngeal carcinoma (NPC). Neither has been independently validated nor their performance compared. We compared their diagnostic performance in an independent population. Methods: We tested blood samples from 819 incident Taiwanese NPC cases (213 early-stage, American Joint Committee on Cancer version 7 stages I and II) diagnosed from 2010 to 2014 and from 1,768 controls from the same region, frequency matched to cases on age and sex. We compared an EBV antibody score using immunoglobulin A antibodies measured by enzyme-linked immunosorbent assay (EBV antibody score) and plasma EBV DNA load measured by real-time PCR followed by next-generation sequencing (NGS) among EBV DNA-positive individuals (EBV DNA algorithm). Results: EBV antibodies and DNA load were measured for 2,522 (802 cases; 1,720 controls) and 2,542 (797 cases; 1,745 controls) individuals, respectively. Of the 898 individuals positive for plasma EBV DNA and therefore eligible for NGS, we selected 442 (49%) for NGS testing. The EBV antibody score had a sensitivity of 88.4% (95% CI, 86.1 to 90.6) and a specificity of 94.9% (95% CI, 93.8 to 96.0) for NPC. The EBV DNA algorithm yielded significantly higher sensitivity (93.2%; 95% CI, 91.3 to 94.9; P = 1.33 × 10 -4 ) and specificity (98.1%; 95% CI, 97.3 to 98.8; P = 3.53 × 10 -7 ). For early-stage NPC, the sensitivities were 87.1% (95% CI, 82.7 to 92.4) for the EBV antibody score and 87.0% (95% CI, 81.9 to 91.5) for the EBV DNA algorithm ( P = .514). For regions with a NPC incidence of 20-100/100,000 person-years (eg, residents in southern China and Hong Kong), these two approaches yielded similar numbers needed to screen (EBV antibody score: 5,656-1,131; EBV DNA algorithm: 5,365-1,073); positive predictive values ranged from 0.4% to 1.7% and 1.0% to 4.7%, respectively. Conclusion: We demonstrated high sensitivity and specificity of EBV antibody and plasma EBV DNA for NPC detection, with slightly inferior performance of the EBV antibody score. Cost-effectiveness studies are needed to guide screening implementation.
Databáze:	MEDLINE
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