Treatment outcomes of Epstein-Barr virus-associated nasopharyngeal carcinoma

Background: Data on treatment outcomes of Epstein-Barr virus (EBV) associated nasopharyngeal carcinoma (NPC) largely comes from endemic regions. There is limited literature regarding the epidemiology and treatment outcomes of EBV-associated NPC in South Africa. Aim: The aim of the study was to compare overall survival (OS) of EBV positive and EBV negative NPC patients. Setting: Groote Schuur Hospital, South Africa. Methods: Data were collected on all patients with histologically confirmed NPC over an 11-year period, including prevalence of EBV, OS, disease-free survival (DFS), loco-regional control (LRC), and impact of treatment interruptions on OS. Results: There were 53 patients in total. Non-keratinising carcinoma was the primary histological subtype (86.8%). The majority of patients had EBV positive NPC (47.2%). The 2- and 5-year OS of EBV positive patients treated with curative intent were significantly higher than EBV negative patients, 84.0% versus 34.0% and 45.0% versus 17.0%, respectively (hazard ratio [HR] 0.25, 95% confidence interval [CI]: 0.10–0.63, p = 0.002). Two-year DFS was 55.0% versus 43.0% (HR: 0.59, 95% CI: 0.18–1.98, p = 0.38) and 2-year LRC were 76.2% versus 46.2% (HR: 0.40, 95% CI: 0.12–1.36, p = 0.13) for EBV positive and EBV negative patients respectively. Conclusion: Treatment of EBV-associated NPC is associated with superior OS compared to EBV negative tumours. Contribution: Epstein-Barr virus was found to be a significant prognostic factor associated with superior OS compared to EBV negative NPC. These findings correlate with literature from endemic and non-endemic regions

Risk factors for Coronavirus disease 2019 (Covid-19) death in a population cohort study from the Western Cape province, South Africa

Risk factors for coronavirus disease 2019 (COVID-19) death in sub-Saharan Africa and the effects of human immunodeficiency virus (HIV) and tuberculosis on COVID-19 outcomes are unknown. We conducted a population cohort study using linked data from adults attending public-sector health facilities in the Western Cape, South Africa. We used Cox proportional hazards models, adjusted for age, sex, location, and comorbidities, to examine the associations between HIV, tuberculosis, and COVID-19 death from 1 March to 9 June 2020 among (1) public-sector “active patients” (≥1 visit in the 3 years before March 2020); (2) laboratory-diagnosed COVID-19 cases; and (3) hospitalized COVID-19 cases. We calculated the standardized mortality ratio (SMR) for COVID-19, comparing adults living with and without HIV using modeled population estimates.Among 3 460 932 patients (16% living with HIV), 22 308 were diagnosed with COVID-19, of whom 625 died. COVID19 death was associated with male sex, increasing age, diabetes, hypertension, and chronic kidney disease. HIV was associated with COVID-19 mortality (adjusted hazard ratio [aHR], 2.14; 95% confidence interval [CI], 1.70–2.70), with similar risks across strata of viral loads and immunosuppression. Current and previous diagnoses of tuberculosis were associated with COVID-19 death (aHR, 2.70 [95% CI, 1.81–4.04] and 1.51 [95% CI, 1.18–1.93], respectively). The SMR for COVID-19 death associated with HIV was 2.39 (95% CI, 1.96–2.86); population attributable fraction 8.5% (95% CI, 6.1–11.1)

Treatment outcomes of Epstein-Barr virus associated nasopharyngeal carcinoma with three-dimensional conformal radiotherapy: A retrospective review

Background: Data on treatment outcomes of Epstein-Barr virus (EBV) associated nasopharyngeal carcinoma (NPC) largely comes from endemic regions. There is limited literature available regarding the epidemiology and treatment outcomes of EBV associated NPC in South Africa. Aim: The primary aim of the study was to determine overall survival (OS) of patients with EBV associated NPC treated over an 11-year period. Setting: Groote Schuur Hospital, between January 2003 and December 2013. Methods: This is a retrospective observational study. Medical records of all patients with histologically confirmed NPC were reviewed. EBV staining was requested on all available archived specimens. All radical patients were treated with three-dimensional conformal radiotherapy (3DCRT). This review assesses the prevalence of EBV associated NPC, OS, disease-free survival (DFS), loco-regional control (LRC), and impact of treatment interruptions on OS. Results: The study population comprised 53 patients. Non-keratinizing carcinoma was the primary histological subtype (86.8%). 25 patients (47.2%) had histologically confirmed EBV positive NPC. The 2-and 5-year OS of radically treated EBV positive patients were significantly higher than EBV negative patients, 84% versus 34% and 45% vs 17% respectively (p=0.002). Two-year DFS was 55% vs 43% (p=0.38) and 2-year LCR were 76.2% vs 46.2% (p=0.13) for EBV positive and EBV negative patients respectively. The mean OS of patients with treatment interruptions was lower compared to those without interruptions (1249 days vs 1440 days). Conclusion: Treatment of EBV associated NPC is associated with superior OS, with a nonsignificant trend for improved DFS and LRC, compared to EBV negative tumours