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Background  In this study, we evaluated the prognostic value of the plasma levels of Epstein-Barr virus (EBV) DNA in patients with nasopharyngeal carcinoma (NPC) at different treatment stages.    Methods  We retrospectively analyzed the Data of 206 patients with NPC. Pre-neoadjuvant chemotherapy (pre-NACT), post-NACT, post-radiotherapy, and post-treatment plasma EBV DNA levels were used to establish prognostic nomograms. The concordance index (C-index) and calibration curves were used to compare the prognostic accuracy of the nomograms. The results were confirmed in a validation cohort consisting of patients who were tested for EBV DNA levels at all four stages of treatment. The Kaplan-Meier method was used to calculate the progression-free survival (PFS) and overall survival (OS). Survival differences were calculated using the log-rank test.    Results  EBV DNA-positive patients had worse 3-year PFS and 5-year OS than EBV DNA-negative patients; this was true for pre-NACT (PFS: 82.7%  vs . 57.3%,  P  < 0.001; OS: 90.9%  vs . 68.7%,  P  = 0.08) and post-NACT (PFS: 85.0%  vs . 50.6%,  P  < 0.001; OS: 91.7%  vs . 65.7%;  P  = 0.001) EBV DNA levels but not for post-radiotherapy (PFS: 72.2%  vs . 60.9%,  P  = 0.192; OS: 73.1%  vs . 77.2%,  P  = 0.472) or post-treatment (PFS: 77.3%  vs . 59.2%,  P  = 0.063; OS: 77.5%  vs . 79.7%,  P  = 0.644) levels. Nomograms combining pre-NACT and post-NACT EBV DNA levels had a superior prognostic ability than those of post-radiotherapy and post-treatment EBV DNA levels.    Conclusion  Pre-NACT EBV DNA levels combined with post-NACT EBV DNA levels can more reliably predict survival outcomes in patients with NPC.

Prognostic Value of Plasma Epstein-Barr Virus DNA Levels Pre- and Post-Neoadjuvant Chemotherapy in Patients With Nasopharyngeal Carcinoma