xRead - Nasal Obstruction (September 2024) Full Articles

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KUANetal.

TABLE XXV.1 (Continued)

Clinical endpoints Conclusion

Study

Year LOE Study design Study groups

Zanget al. 1734

2018 4

Retrospective case series

301 (210 UNKSCC, 91 DNKSCC)

1. OS 2. DMFS

DNKSCC had worse OS (HR 1.982, 95% CI: 1.317–2.526, p = 0.007) and DMFS (HR 1.845, 95% CI: 1.118–3.047, p = 0.017) than UNKSCC KSCC had worse OS (HR 2.7, 95% CI: 1.3–5.5, p = 0.034) than NKSCC

Colaco et al. 1597

2013 4

Retrospective database study (Christie cancer registry database) Retrospective case series

128 (87 NKSCC, 16 KSCC)

OS

Cheung

DNKSCC had worse DMFS, DSS and OS ( p ≤ 0.05) than UNKSCC

2012 4

259 (10 DNKSCC, 249 UNKSCC)

1. OS 2. DSS 3. DMFS

et al. 1602

Abbreviations: AHZ, adjusted hazard ratios; BSCC, basaloid SCC; DMFS, distant metastasis-free survival; DNKSCC, nonkeratinizing SCC, differentiated type; DSS, disease-specific survival; KSCC, keratinizing SCC; NKSCC, nonkeratinizing SCC; OS, overall survival; PYNEH, regional tertiary hospital in Hong Kong; UNKSCC, nonkeratinizing SCC, undifferentiated type; RS, relative survival; SEER, Surveillance, Epidemiology, and End Results.

( p < 0.001). Later, they refined the blood test using novel sequencing-based analysis 1647 and differential methylation pattern analysis 1648 with improved PPV. Role of EBV assessment in NPC

Value

Cumulative evidence suggests that EBV DNA serum testing can provide valuable information to guide clinical decision-making. However, elevated circulating EBV DNA levels during posttreatment follow-up only suggested tumor relapse and did not indicate the tumor location. Diagnostic imaging studies such as CT, MRI, and PET may aid to localize the exact site and extent of the recurrence. Another problem is that PCR-based techniques may produce discrepancies in different laboratories, even when using the same primer/probe sets and experimental conditions. Harmonization between international laboratories, which involves the standardization of buffers and calibrators, is feasible and significantly reduces the variability.

judgments

Aggregate grade of evidence

A (Level 1: 10 studies; Level 2: two studies; Level 3: four studies; Level 4: seven studies) A blood test for quantification of circulating EBV DNA is an ideal biomarker for the clinical management of patients with NPC. It has high sensitivity and specificity for the detection of NPC and correlates with tumor burden, patient survival, diagnosis of recurrence/remission, and early prediction of treatment response. Need for repeat blood draws; EBV not associated with every NPC subtype. The EBV DNA blood test has a lower cost than other diagnostic interventions, such as MRI and PET scan. Preponderance of benefits over harms.

Benefit

Harm

Cost

Policy level Recommendation. Intervention The EBV DNA serum test should be used as a

routine clinical test for patients with NPC for screening, diagnosis, and monitoring treatment response.

Benefits–harm assessment

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