Assessment of the Long-term Diagnostic Performance of a New Serological Screening Scheme in Large-scale Nasopharyngeal Carcinoma Screening

Background: Nasopharyngeal carcinoma (NPC) remains as a major public health burden in Southern China. Over the last decade, Epstein-Barr virus (EBV) serological detection has been the most promising tool used for NPC screening. The present study aims to evaluate the long-term diagnostic performance of a new NPC screening scheme (probability of NPC units [logit P], PROB≥0.65), and compare this with other EBV seromarkers used within 2009-2015. Methods: Enzyme-linked immunosorbent assay (ELISA) for EBV capsid antigen (VCA/IgA) and nuclear antigen-1 (EBNA1/IgA) was performed in 16,712 subjects, who were within 30-59 years old.All subjects were followed up for six years. The area under the receiver operating characteristic curve (AUC) and correlation analyses were preformed to evaluate the diagnostic value of different measures. Furthermore, the rates of early diagnosis in NPC patients were statistically analyzed. Results: The new NPC screening scheme (PROB≥0.65) and the four strategies (VCA/IgA, EBNA1/IgA, VCA/IgA and EBNA1/IgA, and VCA/IgA or EBNA1/IgA) had comparable rates of early diagnosis for NPC (no significant difference was found), but the sensitivity of the new scheme (95.7%) was higher than that of the others. The top three seromarkers with the largest AUC were PROB≥0.65 (AUC:0.926, 95% CI: 0.885-0.966), VCA/IgA or EBNA1/IgA (AUC:0.883, 95% CI:0.824-0.942), and EBNA1/IgA (AUC: 0.866, 95% CI: 0.794-0.938). Conclusion: The new NPC screening scheme (PROB≥0.65) based on VCA/IgA and EBNA1/IgA outperforms the other seromarkers, and making it the preferred serodiagnostic strategy for long-term NPC screening in high-incidence areas.