Prognostic implications of discordant EBER and EBV DNA status in nasopharyngeal carcinoma in endemic areas.

Abstract

e18050 Background: Discordance between Epstein-Barr virus-encoded small RNA (EBER) and Epstein-Barr virus (EBV) DNA status has been observed in certain NPC patients. We aimed to elucidate the prognostic significance of such discordance. Methods: A total of 2,942 NPC patients with known EBV status were included in this analysis. The association between EBER-EBV DNA status and survival outcomes was assessed using multivariable analysis. Sensitivity analyses were performed to validate the robustness of the findings. Results: Among the cohort, 51 patients were EBER-negative, while 2,891 patients were EBER-positive. EBER-negative patients exhibited a higher propensity for locoregional recurrence compared to their EBER-positive counterparts (HR: 2.427, 95% CI: 0.927-6.353, log-rank P = 0.005). Multivariable analysis further identified a significant association between double-negative status and increased risk of locoregional recurrence ( P = 0.001 for double-negative vs. double-positive; P < 0.001 for double-negative vs. EBER+/EBV DNA-), with these associations remaining robust after adjustment for confounding factors and sensitivity analyses. Conclusions: This study highlights the potential prognostic value of assessing EBV status in NPC patients with discordant EBER and EBV DNA results. Association of EBER-EBV DNA combination and survival outcomes in patients with nasopharyngeal carcinoma in whole cohort. Characteristic Non-adjusted Model 1 Model 2 Model 3 HR (95% CI) P value HR (95% CI) P value HR (95% CI) P value HR (95% CI) P value LRFFS  EBER-/EBV DNA- 1.000 (Reference) 1.000 (Reference) 1.000 (Reference) 1.000 (Reference)  EBER-/EBV DNA+ 0.304 (0.069-1.345) 0.116 0.311 (0.070-1.383) 0.125 0.376 (0.079-1.790) 0.219 0.304 (0.063-1.466) 0.138  EBER+/EBV DNA- 0.145 (0.050-0.423) < 0.001 0.139 (0.047-0.406) < 0.001 0.213 (0.065-0.699) 0.011 0.198 (0.059-0.659) 0.008  EBER+/EBV DNA+ 0.229 (0.094-0.557) 0.001 0.216 (0.088-0.528) < 0.001 0.282 (0.102-0.783) 0.015 0.252 (0.089-0.710) 0.009 OS  EBER-/EBV DNA- 1.000 (Reference) 1.000 (Reference) 1.000 (Reference) 1.000 (Reference)  EBER-/EBV DNA+ 0.870 (0.192-3.936) 0.856 0.832 (0.178-3.879) 0.815 1.387 (0.246-7.821) 0.711 1.278 (0.225-7.252) 0.782  EBER+/EBV DNA- 0.214 (0.059-0.774) 0.019 0.208 (0.056-0.765) 0.018 0.484 (0.107-2.193) 0.346 0.444 (0.098-2.007) 0.291  EBER+/EBV DNA+ 0.425 (0.144-1.254) 0.121 0.415 (0.138-1.247) 0.117 0.719 (0.190-2.722) 0.628 0.681 (0.181-2.566) 0.570 Model 1 was adjusted for age and gender. Model 2 was adjusted for age, gender, T category, N category, and histology. Model 3 was adjusted for age, gender, T category, N category, histology, induction and concurrent chemotherapy. EBER, EBV-encoded small RNA; EBV, Epstein-Barr virus, LRFFS, locoregional failure-free survival; OS, overall survival.