Evaluating the Prognostic Relevance of Pre-Treatment Epstein–Barr Virus Levels in Non-Endemic Pediatric Nasopharyngeal Carcinoma

Background/Objectives: Pediatric nasopharyngeal carcinoma (NPC) is a very rare childhood cancer strongly associated with Epstein–Barr virus (EBV) infection. We investigated the prognostic value of EBV DNA on staging and outcome in pediatric NPC from two large study centers, the Children’s Oncology Group (COG) in North America and the German Society of Pediatric Oncology and Hematology (GPOH) in Europe. Methods: Samples collected from NPC patients treated on the COG study ARAR0331 between 2006 and 2012 and the GPOH NPC protocol between 2003 and 2021 were retrospectively analyzed for the level of available plasma (P-EBV) or whole-blood EBV DNA (WB-EBV), both pre-treatment and post-induction chemotherapy. Patients were dichotomized into high and low groups based on the median pre-treatment EBV value. Results: Pre-treatment EBV DNA levels from 102 patients (50 and 23 P-EBV DNA from the COG and GPOH, respectively, and 29 WB-EBV from GPOH) and post-induction EBV DNA levels from 61 patients (31 and 12 P-EBV DNA from the COG and GPOH, respectively, and 18 WB-EBV DNA from GPOH) were evaluated. Patient characteristics, including age and disease stage, were not associated with high and low P-EBV values in any cohort. Disease stage correlated with high EBV levels in the WB-EBV GPOH cohort (p = 0.014). Pre-treatment P-EBV and WB-EBV levels showed no significant association with 5-year event-free survival (EFS: COG p = 0.65, GPOH P-EBV: p = 0.08, GPOH WB-EBV: p = 0.75) or 5-year overall survival (OS: COG p = 0.90, GPOH P-EBV p = 0.17, GPOH WB-EBV p = 0.19). Conclusions: Our study could not establish a significant correlation between outcome and pre-treatment EBV DNA in pediatric NPC patients from non-endemic areas.

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Journal
Cancers
Published
2026-08-28
DOI
https://doi.org/10.3390/cancers18172800
Primary Topic
Head and Neck Cancer Studies
Type
article
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article

Evaluating the Prognostic Relevance of Pre-Treatment Epstein–Barr Virus Levels in Non-Endemic Pediatric Nasopharyngeal Carcinoma

Junne Kamihara, David Tsai Ting, Quynh‐Thu Le, Randall T. Hayden et al.
Cancers
Head and Neck Cancer Studies
article

Evaluating the Prognostic Relevance of Pre-Treatment Epstein–Barr Virus Levels in Non-Endemic Pediatric Nasopharyngeal Carcinoma

Junne Kamihara, David Tsai Ting, Quynh‐Thu Le, Randall T. Hayden, Jin Piao, Hans‐Joachim Wagner, Kenneth Chen, Ahmed Farrag, Carlos Rodríguez‐Galindo, Udo Kontny, Benjamin A. Pinsky, Sue S. Yom, Theodore W. Laetsch, Tristan Römer, Hans Christiansen, Yanbo Yang, Lindsay Younis, Robyn D. Gartrell, Christopher Szot, Nadia Thibeau, Allison Poore
article en

Abstract

Background/Objectives: Pediatric nasopharyngeal carcinoma (NPC) is a very rare childhood cancer strongly associated with Epstein–Barr virus (EBV) infection. We investigated the prognostic value of EBV DNA on staging and outcome in pediatric NPC from two large study centers, the Children’s Oncology Group (COG) in North America and the German Society of Pediatric Oncology and Hematology (GPOH) in Europe. Methods: Samples collected from NPC patients treated on the COG study ARAR0331 between 2006 and 2012 and the GPOH NPC protocol between 2003 and 2021 were retrospectively analyzed for the level of available plasma (P-EBV) or whole-blood EBV DNA (WB-EBV), both pre-treatment and post-induction chemotherapy. Patients were dichotomized into high and low groups based on the median pre-treatment EBV value. Results: Pre-treatment EBV DNA levels from 102 patients (50 and 23 P-EBV DNA from the COG and GPOH, respectively, and 29 WB-EBV from GPOH) and post-induction EBV DNA levels from 61 patients (31 and 12 P-EBV DNA from the COG and GPOH, respectively, and 18 WB-EBV DNA from GPOH) were evaluated. Patient characteristics, including age and disease stage, were not associated with high and low P-EBV values in any cohort. Disease stage correlated with high EBV levels in the WB-EBV GPOH cohort (p = 0.014). Pre-treatment P-EBV and WB-EBV levels showed no significant association with 5-year event-free survival (EFS: COG p = 0.65, GPOH P-EBV: p = 0.08, GPOH WB-EBV: p = 0.75) or 5-year overall survival (OS: COG p = 0.90, GPOH P-EBV p = 0.17, GPOH WB-EBV p = 0.19). Conclusions: Our study could not establish a significant correlation between outcome and pre-treatment EBV DNA in pediatric NPC patients from non-endemic areas.

CancersVol. 18(17)
Children's Oncology Group (CH), University of Southern California (US), St. Jude Children's Research Hospital (US), Children's Hospital of Philadelphia (US), Johns Hopkins University (US), University of California, San Francisco (US), Justus-Liebig-Universität Gießen (DE), Johns Hopkins Medicine (US), Medizinische Hochschule Hannover (DE), Integrated Oncology (United States) (US), Southwestern Medical Center (US), Frederick National Laboratory for Cancer Research (US), Children's Oncology Group (US), Center for Cancer Research (US), Dana-Farber/Boston Children's Cancer and Blood Disorders Center (US), Southwestern Medical Center (US), The University of Texas Southwestern Medical Center (US), RWTH Aachen University (DE), Assiut University (EG), Stanford University (US)
Rally Foundation, St. Baldrick's Foundation, Swim Across America, National Cancer Institute, Congressionally Directed Medical Research Programs
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Openalex Percentile: Top 8%
Head and Neck Cancer Studies
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