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However, their quantitative values and optimal positive thresholds remain inconsistent, hindering clinical application. This meta-analysis systematically assesses their prognostic value in ENKTL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Relevant studies from PubMed, Embase, Web of Science, and Cochrane Library were searched until 24 December, 2025. Eligible studies reported hazard ratios (HRs) for overall survival (OS) based on Pre-treatment EBV DNA levels or tumor EBER positivity. Subsequently, Pooled HRs with 95% confidence intervals (CIs) were calculated via random-effects models. Next, Subgroup analyses examined different blood compartments, EBV DNA cut-offs, and study design. Additionally, Heterogeneity (I\u00b2) and publication bias (Egger\u2019s test) were assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In total, 17 studies from 15 articles were enrolled in this meta-analysis, including 15 on EBV DNA and 2 on EBER. These studies demonstrated that elevated pre-treatment EBV DNA level (HR\u2009=\u20093.04, 95% CI 1.97\u20134.69;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001, I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200938%) and high tumor EBER positivity thresholds of \u2265\u200975% (HR\u2009=\u20095.53, 95%CI2.21-14.38;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001, I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%) independently predicted reduced survival. Moreover, Stratification by EBV DNA cut-off (500 copies\/ML) showed significantly higher mortality risk in the \u2265\u2009500 group (HR\u2009=\u20092.82, 95% CI 1.84\u20134.31;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001) compared to the &lt;\u2009500 group (HR\u2009=\u20092.66, 95% CI 0.56\u201312.72;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.22). Furthermore, Egger\u2019s test suggested no publication bias(\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.111). Finally, Sensitivity analyses suggested the robustness and credibility of our results.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>High pre-treatment EBV DNA load (cut-off of \u2265\u2009500 copies\/mL) and high EBER-Positive Cell Proportion (\u2265\u200975%) predict poor survival in ENKTL. Those quantitative EBV Biomarkers may serve as practical biomarkers for risk stratification and guiding therapeutic decisions in this patient population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13027-026-00752-9","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T09:52:20Z","timestamp":1775037140000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Prognostic significance of quantitative EBV biomarkers in extranodal NK\/T-cell lymphoma: a meta-analysis of EBV DNA load and EBER-positive cell proportion"],"prefix":"10.1186","volume":"21","author":[{"given":"Xue song","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Di","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xia","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Xia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anzhou","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"issue":"12","key":"752_CR1","doi-asserted-by":"publisher","first-page":"2186","DOI":"10.1038\/sj.leu.2403955","volume":"19","author":"YL Kwong","year":"2005","unstructured":"Kwong YL. 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