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280

KUANetal.

TABLE XXV.2 (Continued)

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusion

Xie et al. 1632

40 studies, 27,235 NPCs

OS

1. When cutoff values of 2000, 0, and 0 copies/mL were used for pre-DNA, mid-DNA, and post-DNA, patients with values above these cutoffs were associated with > 2.5-fold increased risk of death (all p < 0.05) 2. Higher pre-DNA, detectable mid-DNA, and detectable post-DNA levels are significantly correlated with poorer outcomes High EBV DNA levels indicate poor prognosis and reduced long-term survival in patients with newly diagnosed NPC 1. Pooled HR for OS: pre-DNA 2.78, post-DNA 5.43 2. High expression levels of EBV DNA predict poor prognosis in NPC Pre-DNA, mid-DNA, post-DNA, and EBV DNA clearance rates are prognostic factors for survival in NPC patients

2019 1

Systematic

reviewand meta analysis

Liuet al. 1631

2017 1

Systematic review

16 studies, 7698 NPCs 1. OS 2. PFS 3. DFS 4. RFS 5. DMFS

Zhang et al. 1630

23 studies, 10,732 NPCs OS

2016 1

Systematic

reviewand meta analysis reviewand meta analysis

Zhang et al. 1629

2015 1

Systematic

14 studies, 7836 NPCs 1. OS 2. PFS 3. DMFS 4. LRFS

2-2. Supplement to the TNM staging system Hui et al. 1639 2020 2 Prospective cohort

Training set (745 NPCs) Internal validation (340NPCs) External validation (837NPCs)

OS

Combining post-DNA levels and TNM staging improved risk stratification in NPC patients

Lee et al. 1637

Combined stage groups revealed better survival prediction compared to the 8th edition of the TNM staging system Integration of pre-DNA into the 8th edition of the TNM staging improved outcome prediction, especially for patients who may benefit from treatment intensification Combined staging system can outperform conventional TNM staging groups for predicting survival rates

2019 3

Prospective cohort

518NPCs

1. OS 2. PFS 3. DSS

Kitpanit

2019 3

Prospective cohort

205NPCs

OS

et al. 1638

Li et al. 1640

PFS

2021 4

Retrospective case series

2354NPCs (training set 1372,

internal validation 672, external validation 310)

(Continues)

3 The role of HPV in NPC HPV + NPC is relatively rare compared to EBV + NPC in endemic areas, and thus there are few associated stud ies (Table XXV.3). Wu et al. analyzed HPV status from the SEER database and found that the incidence of HPV associated NPC patients was 2.3% among 9943 head and

neck SCC patients. They found that HPV infection was not a clinically prognostic marker for NPC patients, although controversial results were noted in some studies. 1649–1656 In a large study conducted in Southern China, among 1328 NPC patients, there were 91.9% EBV + , 7.7% HPV + , and only 0.6% coinfected with both viruses. They found that EBV–/HPV + NPC patients was associated with signifi-