Prospective assessment of a nasopharyngeal carcinoma risk score in a population undergoing screening. Issue 10 (24th December 2020)

• Record Type: Journal Article
• Authors: Chen, Geng‐Hang; Liu, Zhiwei; Ji, Ming‐Fang; Pfeiffer, Ruth M.; Huang, Qi‐Hong; Lu, Yu‐Qiang; Xie, Shang‐Hang; Lin, Chu‐Yang; Chen, Wen‐Jie; Chen, Xiao‐Xia; Ling, Wei; Fan, Yu‐Ying; Yu, Xia; Wu, Biao‐Hua; Wei, Kuang‐Rong; Rao, Hui‐Lian; Guo, Xiang; Hong, Ming‐Huang; Ma, Jun; Liu, Qing; Hildesheim, Allan; Cao, Su‐Mei
• Is Part Of: International journal of cancer. Volume 148:Issue 10(2021)
• Page Start: 2398
• Page End: 2406
• Publication Date: 2020-12-24
• Subjects: cohort study -- Epstein‐Barr virus -- nasopharyngeal carcinoma -- risk model -- risk prediction -- screening; Cancer -- Periodicals; Cancer -- Prevention -- Periodicals; 616.994
• DOI: 10.1002/ijc.33424
• Languages: English
• ISSNs: 0020-7136

Abstract

Abstract: Despite evidence suggesting the utility of Epstein‐Barr virus (EBV) markers to stratify individuals with respect to nasopharyngeal carcinoma (NPC) risk in NPC high‐risk regions, no validated NPC risk prediction model exists. We aimed to validate an EBV‐based NPC risk score in an endemic population undergoing screening for NPC. This prospective study was embedded within an ongoing NPC screening trial in southern China initiated in 2008, with 51 235 adult participants. We assessed the score's discriminatory ability (area under the receiver‐operator‐characteristics curve, AUC). A new model incorporating the EBV score, sex and family history was developed using logistic regression and internally validated using cross‐validation. AUCs were compared. We also calculated absolute NPC risk combining the risk score with population incidence and competing mortality data. A total of 151 NPC cases were detected in 2008 to 2016. The EBV‐based score was highly discriminating, with AUC = 0.95 (95% CI = 0.93‐0.97). For 90% specificity, the score had 87.4% sensitivity (95% CI = 81.0‐92.3%). As specificity increased from 90% to 99%, the positive predictive value increased from 2.4% (95% CI = 1.9‐3.0%) to 12.5% (9.9‐15.5%). Correspondingly, the number of positive tests per detected NPC case decreased from 272 (95% CI = 255‐290) to 50 (41‐59). Combining the score with other risk factors (sex, first‐degree family history of NPC) did not improve AUC. Men aged 55 to 59 years with the highest risk profile had the highest 5‐year absolute NPC risk of 6.5%. We externally validated the discriminatory accuracy of a previously developed EBV score in a high‐risk population. Adding nonviral risk factors did not improve NPC prediction. Abstract : What's new? Evidence suggests that markers of Epstein‐Barr virus (EBV) infection are useful in screening for nasopharyngeal carcinoma (NPC). Few prospective studies, however, have validated the performance of EBV‐based risk scores for NPC. In this prospective validation study with data for more than 51 000 participants, EBV‐based risk score based on the combination of IgA antibodies against viral capsid antigen and EBV nuclear antigen 1 was found to be highly discriminating for NPC over follow‐up periods lasting five years. The findings indicate that EBV‐based scores could be valuable risk‐prediction tools for early NPC diagnosis, leading to improved clinical outcomes.