Influence of blood EBV-DNA level on survival of patients with nasopharyngeal cancer on immune checkpoint inhibitors: a meta-analysis
Year: 2025
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: OBJECTIVES: Pretreatment plasma Epstein–Barr virus (EBV) DNA is a promising biomarker in nasopharyngeal cancer (NPC). However, its prognostic significance in patients receiving immune checkpoint inhibitors (ICIs) remains unclear. This meta-analysis evaluated the association between pretreatment EBV-DNA levels and survival outcomes in NPC patients treated with ICIs. METHODS: PubMed, Embase, and Web of Science were searched up to June 29, 2025. Eligible longitudinal studies included adult NPC patients treated with ICIs, with pretreatment EBV-DNA assessed by quantitative PCR and survival outcomes reported as hazard ratios (HRs). Pooled analyses used random-effects models accounting for the potential influence of heterogeneity. RESULTS: Thirteen cohorts from 12 studies, comprising 1,507 patients, were included. Most cohorts were prospective; two were retrospective. Overall, high pretreatment EBV-DNA was significantly associated with poorer progression-free survival (PFS; HR = 1.72, 95% CI: 1.46 to 2.03, p < 0.001; I² = 0%) and overall survival (OS; HR = 2.03, 95% CI: 1.50 to 2.77, p < 0.001; I² = 18%). Sensitivity analyses by excluding one study at a time showed similar results. Subgroup analyses for the outcome of PFS showed consistent associations across study design (prospective vs. retrospective), treatment line (first vs. later), concurrent therapy, cutoff thresholds (< 7,800 vs. ≥ 7,800 copies/mL), follow-up duration, analytic model, and study quality (all p for subgroup differences > 0.05). CONCLUSIONS: High pretreatment EBV-DNA levels predict significantly worse PFS and OS in NPC patients receiving ICIs. Pretreatment EBV-DNA may serve as a practical biomarker for risk stratification and treatment decision-making in this population. CLINICAL TRIAL NUMBER: Not applicable.
Source: Infectious Agents and Cancer
Authors: Yanbing Li, Lingyu Cai, Hongbo Zuo
Institution: Jiujiang First People's Hospital
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,190
OpenAlex ID: W4416949474