Serum EA-IgA and d-dimer, but not VCA-IgA, are associated with prognosis in patients with nasopharyngeal carcinoma: a meta-analysis

BACKGROUND: Patients with nasopharyngeal cancer (NPC) differ in prognosis, even at the same stage; therefore, new biomarkers are urgently required to identify early-stage NPC patients at high risk of poor prognosis. Although Epstein–Barr virus (EBV) DNA has been used for prognosis, the value of many other biomarkers expressed during the infection cycle of EBV remains unclarified. This study aimed to evaluate the prognostic potential of EA-IgA, VCA-IgA and d-dimer in patients with NPC. METHODS: Electronic databases, including PubMed, Embase and Web of Science, were searched up to February 1, 2021. Pooled data were extracted from studies that evaluated the relationship between NPC and overall survival (OS), distant metastasis-free survival (DMFS) or disease-free survival (DFS) and then were subjected to a meta-analysis. RESULTS: Nine studies with 5729 patients were included in this meta-analysis. In patients with NPC, EA-IgA levels significantly predicted OS (HR = 1.63, 95% CI 1.07–2.48). d-Dimer levels significantly predicted OS (HR = 1.75, 95% CI 1.24–2.47) and DMFS (HR = 1.91, 95% CI 1.31–2.79). However, high levels of VCA-IgA were not associated with OS (HR = 1.24, 95% CI 0.95–1.60), DMFS (HR = 1.41, 95% CI 0.92–2.17) or DFS (HR = 2.39, 95% CI 0.78–7.26). CONCLUSIONS: The present findings reveal that EA-IgA and d-dimer, but not VCA-IgA, can be used as prognostic biomarkers in NPC.