Management of locally recurrent nasopharyngeal carcinoma

Efficacy and safety of Anlotinib in combination with gemcitabine and cisplatin as a first-line treatment for recurrent or metastatic nasopharyngeal carcinoma: A single-arm clinical trial

The effectiveness and safety of combining anlotinib with gemcitabine and cisplatin in the first-line treatment of recurrent/metastatic nasopharyngeal carcinoma (R/M NPC) have not been definitively established. This research seeks to investigate the potential benefits and risks of utilizing this combination therapy in the first-line management of R/M NPC. The research involved 22 individuals diagnosed with R/M NPC and who had not undergone any previous treatment. These patients were administered a concomitant therapy of anlotinib, gemcitabine, and cisplatin in cycles occurring every 3 weeks. The primary focus of the study was to assess progression-free survival (PFS), while secondary endpoints included overall survival (OS), disease control rate (DCR), and objective response rate (ORR). The findings revealed that the median PFS duration for patients with R/M NPC receiving the GPA regimen as a first-line treatment was 12.6 months, with a 95% confidence interval (CI): 0.1 to 25.2. The median OS was reported as 37.4 months, with 95% CI: 28.0 to 46.8. The DCR in this study was 95.5%, while the ORR was 63.6%. Anlotinib has demonstrated a degree of effectiveness in the initial treatment of R/M NPC, while maintaining an acceptable level of safety.

Classifications of Postradiation Nasopharyngeal Necrosis for Guiding Transnasal Endoscopic Nasopharyngeal Skull Base Surgery

OBJECTIVE

Postradiation nasopharyngeal necrosis (PRNN) is a severe postradiation complication of nasopharyngeal carcinoma. PRNN not only severely impacts the quality of life but also endangers the lives of patients. Definite grades of PRNN and their corresponding standard surgical procedures are lacking. we aimed to establish the classifications of PRNN for transnasal endoscopic skull base surgery (TESS).

METHODS

We enrolled 82 postirradiation NPC patients with PRNN, 75 of whom received TESS. PRNN was categorized into four grades: I, necrosis of the nasopharyngeal mucosa and submucosal muscularis; II, necrosis extending to the pharyngobasilar fascia; III, necrotic area breaking through the pharyngobasilar fascia and involving the internal carotid artery (ICA); IV, necrosis encompassing the ICA or invading the posterior cranial nerves. Overall survival (OS) analysis based on the PRNN grades was assessed. Headache was assessed using a numeric rating scale.

RESULTS

The classifications of PRNN were as follows: Grade I, 18.3% (n = 15); Grade II, 30.5% (n = 25); Grade III, 24.4% (n = 20); Grade IV, 26.8% (n = 22). After surgery, headache was alleviated in most PRNN patients to varying degrees. By the last follow-up visit, 24 patients had died, including 6 of 7 in the unoperated group and 18 out of 75 in the operated group.

CONCLUSION

The classifications of PRNN grade provide an effective guideline for the TESS treatment of PRNN.

LEVEL OF EVIDENCE

4 Laryngoscope, 135:1581-1589, 2025.

Ursolic acid induces apoptosis in nasopharyngeal carcinoma cells through the P53 signaling pathway: a network pharmacology and experimental validation study

Nasopharyngeal carcinoma (NPC) is a malignant neoplasm that is highly prevalent in East Asia and presents significant therapeutic challenges due to limited treatment options and severe adverse effects. Ursolic acid (UA) is a pentacyclic triterpenoid with anticancer activity in various tumors; however, its mechanism of action in NPC remains unclear. This study integrated network pharmacology with experimental validation to elucidate the molecular mechanism underlying the effect of UA against NPC. Screening of a network pharmacology database identified 39 targets common to UA and NPC, among which P53, STAT3, Bcl-2, IL1B, and CASP3 showed high node degrees in the protein-protein interaction network. Gene Ontology analysis revealed that these targets were primarily enriched in stress response and apoptosis regulation, whereas Kyoto Encyclopedia of Genes and Genomes analysis indicated significant enrichment in the P53 signaling and apoptosis pathways. UA dose-dependently inhibited the proliferation of the NPC cell lines S18 and S26 (p < 0.01), and induced apoptosis, as demonstrated by Annexin V-FITC/PI double fluorescence staining and confirmed by Hoechst 33,342 staining showing nuclear condensation. UA also caused mitochondrial membrane depolarization, as indicated by JC-1 staining. Western blot analysis showed significant upregulation of P53 and the pro-apoptotic protein BAX (p < 0.01), and downregulation of the anti-apoptotic protein Bcl-2 (p < 0.01) following UA treatment. This study is the first to show that UA induces apoptosis in NPC cells by activating the P53 signaling pathway using network pharmacology and experimental validation.

Rhamnocitrin induces apoptosis of human nasopharyngeal carcinoma by inhibiting IGF-1R signaling pathway in vitro

This study explored rhamnocitrin's apoptotic effects on human nasopharyngeal carcinoma cell lines (CNE-2/C666-1) and underlying mechanisms. Following treatment with varying concentrations, cell proliferation, apoptosis, and protein expression were analyzed using MTT assay, Hoechst/Annexin V-FITC/PI staining, and western blot. Results showed rhamnocitrin inhibited cell proliferation, induced apoptosis, downregulated IGF-1R, Erk1/2, and Akt phosphorylation, and activated caspase 3, caspase 8, caspase 9, and Bax while inhibiting survivin, Bcl-2, and Mcl-1. In conclusion, rhamnocitrin induces apoptosis in nasopharyngeal carcinoma cells by inhibiting the IGF-1R signaling pathway and its downstream effectors Akt and Erk1/2.

Reirradiation based on diffusion-weighted magnetic resonance imaging-guided dose- painting for locally advanced recurrent nasopharyngeal carcinoma: a phase 2 randomized controlled trial

INTRODUCTION

The effect of diffusion-weighted magnetic resonance imaging (DWI)-guided dose-painting intensity-modulated radiation therapy (DP-IMRT) on locally advanced recurrent nasopharyngeal carcinoma (NPC) remains unclear. This study aimed to compare the outcomes and toxicities of DWI-guided DP-IMRT in patients with locally recurrent NPC.

METHODS

In this prospective trial, 150 patients with locally advanced recurrent NPC were randomly assigned (1:1) to receive reirradiation with DWI-guided DP-IMRT (DWI group, n = 75) or conventional MRI-based IMRT (MRI group, n = 75). In the DWI group, DWI-guided gross tumor volume received escalation to 65.4 Gy/30 fx in 2.18 Gy per fraction, while in the MRI group, the planning target volume was irradiated at 60 Gy/30fx in 2.0 Gy per fraction. The trial was registered at Chictr.org.cn (ChiCTR2100052340) on October 24, 2021. Survival rates were compared, and multivariate analyses were conducted.

RESULTS

The median follow-up duration was 16 months. Compared with the MRI group, patients in the DWI group had better 18-month progression-free survival (PFS) 75.1% vs. 53.6%; P = 0.006), local recurrence-free survival (LRFS) (83.4% vs. 61.8%; P = 0.010), and locoregional recurrence-free survival (73.1% vs. 64.9%; P = 0.025). Grade 3-4 toxicities between the two groups showed no significant difference. Multivariate analysis revealed that DWI-guided DP-IMRT was an independent prognostic factor for PFS and LRFS.

CONCLUSION

Compared with conventional MRI-based IMRT, DWI-guided DP-IMRT improved PFS in patients with recurrent NPC without increasing acute and late toxic effects.

Establishment of a deep-learning-assisted recurrent nasopharyngeal carcinoma detecting simultaneous tactic (DARNDEST) with high cost-effectiveness based on magnetic resonance images: a multicenter study in an endemic area

BACKGROUND

To investigate the feasibility of detecting local recurrent nasopharyngeal carcinoma (rNPC) using unenhanced magnetic resonance images (MRI) and optimize a layered management strategy for follow-up with a deep learning model.

METHODS

Deep learning models based on 3D DenseNet or ResNet frames using unique sequence (T1WI, T2WI, or T1WIC) or a combination of T1WI and T2WI sequences (T1_T2) were developed to detect local rNPC. A deep-learning-assisted recurrent NPC detecting simultaneous tactic (DARNDEST) utilized DenseNet was optimized by superimposing the T1WIC model over the T1_T2 model in a specific population. Diagnostic efficacy (accuracy, sensitivity, specificity) and examination cost of a single MR scan were compared among the conventional method, T1_T2 model, and DARNDEST using McNemar's Z test.

RESULTS

No significant differences in overall accuracy, sensitivity, and specificity were found between the T1WIC model and T1WI, T2WI, or T1_T2 models in both test sets (all P > 0.0167). The DARNDEST had higher accuracy and sensitivity but lower specificity than the T1_T2 model in both the internal (accuracy, 85.91% vs. 84.99%; sensitivity, 90.36% vs. 84.26%; specificity, 82.20% vs. 85.59%) and external (accuracy, 86.14% vs. 84.16%; sensitivity, 90.32% vs. 84.95%; specificity, 82.57% vs. 83.49%) test sets. The cost of a single MR examination using DARNDEST was $330,724 (internal) and $328,971 (external) with a hypothetical cohort of 1,000 patients, relative to $313,250 of the T1_T2 model and $340,865 of the conventional method.

CONCLUSIONS

Detecting local rNPC using unenhanced MRI with deep learning is feasible and DARNDEST-driven follow-up management is efficient and economic.

Efficacy and safety of cadonilimab (PD-1/CTLA-4 bispecific) in combination with chemotherapy in anti-PD-1-resistant recurrent or metastatic nasopharyngeal carcinoma: a single-arm, open-label, phase 2 trial

BACKGROUND

We aimed to evaluate the efficacy and safety of cadonilimab (anti-PD-1 and CTLA-4 bispecific antibody) plus TPC chemotherapy (NAB-paclitaxel, cisplatin or lobaplatin, and capecitabine) in patients with recurrent or metastatic nasopharyngeal carcinoma (RM-NPC) who failed to PD-1 inhibitor-containing regimens.

METHODS

In this single-arm, open-label, phase 2 study, RM-NPC patients who failed to at least one line of systemic chemotherapy and anti-PD-1 immunotherapy were enrolled and received cadonilimab plus TPC chemotherapy every 3 weeks for up to 6 cycles, followed by cadonilimab plus capecitabine every 3 weeks for a maximum of 2 years. The primary endpoint was the objective response rate (ORR). The secondary endpoints included progression-free survival (PFS), overall survival (OS), duration of response (DoR), and safety.

RESULTS

Twenty-five patients were enrolled (84% male; median age 44 years (range, 24-60)), with a median follow-up of 10.2 months. The ORR was 68%, with 3 complete responses, 14 partial responses, and 6 stable diseases. The median DoR was 9.1 months (95% CI, 3.8-14.5 months). The median PFS was 10.6 months (95% CI, 5.2-16.0 months). The 12-month OS was 75.6%. Treatment was well tolerated. Grade 3 or 4 treatment-related adverse events occurred in 12 (48%) patients. Fourteen patients (56%) experienced potentially immune-related adverse events (irAEs). One patient experienced a grade 3 immune-related rash and another patient had grade 3 immune-related lipase increased. No treatment-related death occurred.

CONCLUSIONS

Cadonilimab in combination with TPC chemotherapy demonstrated promising antitumoral efficacy and manageable toxicities in patients with RM-NPC who failed frontline immunotherapy. Further trials are warranted to confirm and expand these findings.

TRIAL REGISTRATION

This trial was registered at chictr.org.cn (ChiCTR2200067057).

The correlation between epithelial-mesenchymal transition classification and MMP2 expression of circulating tumor cells and prognosis of advanced or metastatic nasopharyngeal carcinoma

Background

Epithelial-mesenchymal transition (EMT) and circulating tumor cells (CTCs) are key prognostic factors in nasopharyngeal carcinoma (NPC). However, the role of EMT status in CTCs for predicting outcomes in advanced NPC treated with radiotherapy after induction chemotherapy remains unclear.

Methods

A total of 143 CTC tests from 95 advanced/metastatic NPC patients were analyzed before, during, and after radiotherapy, with a 60-month follow-up. CTC count, matrix metalloproteinase 2 (MMP2)) protein expression, and EMT subtypes were examined.

Results

During radiotherapy, CTC counts increase but decrease afterward. Patients with higher pre-radiotherapy tumor-node-metastasis (TNM) stages have lower total and M-subtype CTC counts. Higher T and TNM stages during radiotherapy correlate with increased EMT-state CTCs, especially hybrid CTCs. EA/IgG-positive patients have a higher number of hybrid CTCs and E-type (epithelial + hybrid) CTCs, while EBV-EA-negative patients have more mesenchymal CTCs. A higher post-radiotherapy CTC count predicts relapse, and the positive rate of MMP2 expression on hybrid and epithelial CTCs is higher than that on mesenchymal CTCs.

Conclusion

EMT status, particularly in hybrid CTCs, is a potential prognostic marker for relapse in advanced NPC after radiotherapy.

Nomograms Based on Blood-Based Biomarkers for Predicting Prognosis in Locally Advanced Nasopharyngeal Carcinoma Patients

Purpose: This study aimed to investigate the prognostic significance of the platelet-to-platelet distribution width ratio (P/PDW), systemic inflammation response index (SIRI), and systemic immune inflammation index (SII) in patients with locally advanced nasopharyngeal carcinoma (LA-NPC). Methods: A total of 549 LA-NPC patients were included in this retrospective analysis. Clinicopathological characteristics and blood test data were obtained from patient records. Receiver operating characteristic (ROC) curve analysis was employed to determine the optimal cutoff values for P/PDW, SIRI, and SII. The χ 2 test was used to compare clinicopathological characteristics. Survival rates were calculated using the Kaplan-Meier method. Prognostic factors were evaluated using univariate and multivariate analyses via Cox regression. Additionally, we developed a nomogram to predict outcomes and assessed its acuracy using the concordance index (C-index) and a calibration curve. Results: The median follow-up time was 47.1 months. Elevated P/PDW levels were associated with advanced N stages and higher risks of disease progression (all p  < 0.05). Patients with high SIRI or SII levels were more likely to have advanced T stages, clinical stages, and to develop metastasis (all p  < 0.05). Univariate analysis revealed that P/PDW, SIRI, SII, and T stage were significantly correlated with both overall survival (OS) and progression-free survival (PFS; all p  < 0.05). Clinical stage was significantly related only to PFS (p=0.009). Multivariate Cox regression analysis identified P/PDW (hazard ratio (HR): 0.544, 95% confidence interval (CI): 0.390-0.759, p  < 0.001; HR: 0.406, 95% CI: 0.268-0.615, p  < 0.001) and T stage (HR: 0.539, 95% CI: 0.378-0.768, p=0.001; HR: 0.545, 95% CI: 0.364-0.815, p=0.003) as independent prognostic factors for both OS and PFS, while SIRI (HR: 0.525, 95% CI: 0.333-0.827, p=0.006) was an independent predictor of OS. Nomogram C-indexes for the nomogram of OS were 0.717 and PFS were 0.711, respectively. Survival predictions and actual survival were consistent according to the calibration curve. Conclusion: Our findings suggest that P/PDW is a convenient and effective marker for predicting outcomes in LA-NPC patients.

Utilization of 18F-FDG Standardized Uptake Value and Metabolic Tumor Volume to Predict Local Failure in Nasopharyngeal Carcinoma

INTRODUCTION

The aim was to evaluate the prognostic values of pretreatment 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) parameters for predicting local failure in nasopharyngeal carcinoma (NPC) patients in the intensity-modulated radiotherapy (IMRT) era.

METHODS

Retrospective analysis was performed on 759 patients with NPC who underwent pretreatment 18F-FDG PET. The optimal cutoff values for maximum standardized uptake value (SUVmax) and metabolic tumor volume (MTV) were determined by receiver operating characteristic curve analysis. Univariate and multivariate analysis was performed to identify the prognostic factors influencing local failure-free survival (LFFS). Survival curves for the different risk groups were plotted using the Kaplan-Meier survival analysis method and compared using the log-rank test.

RESULTS

The median follow-up period was 49.0 months (range: 3.0-118.0 months). The optimal cutoff of SUVmax and MTV were 7.44 and 22.21 mL, respectively. Patients with higher SUVmax and MTV were associated with worse LFFS. The survival curves of different groups were significantly separated. The univariate analysis showed the statistical significance of SUVmax, MTV, and their composite in LFFS (p = 0.002 for SUVmax; p = 0.001 for MTV; p < 0.002 for their composite). The multivariate analysis showed that higher SUVmax and MTV was an independent negative prognostic factor for LFFS (HR = 1.805, 95% CI: 1.004-3.245, p = 0.049). The subgroups of stages III-IV further confirmed the impact of SUVmax and MTV on LFFS (HR = 1.884, CI: 1.087-3.708, p = 0.026).

CONCLUSION

Patients with higher SUVmax and MTV were associated with local failure as well as in the III-IV advanced stage.

Down-regulation of PCK2 enhanced the radioresistance phenotype of nasopharyngeal carcinoma

PURPOSE

Radiotherapy is the main treatment for non-distant metastatic nasopharyngeal carcinoma (NPC). However, about 15% of NPC patients still experience local tumor recurrence after radiotherapy. The mechanisms underlying the radioresistance of NPC have not been fully understood. This study explored the role of phosphoenolpyruvate carboxykinase2 (PCK2) in NPC radiosensitivity.

METHODS

Two NPC cell lines, SUNE-1 and 5-8 F, were enrolled in this research, and their radioresistant counterparts, SUNE-1R and 5-8FR were obtained by long-term exposure to γ-ray (2 Gy*30 times). Cells response to ionizing radiation (IR) was determined by colony formation assay (C.F.A). Immunofluorescence, microsphere formation assay and ferroptosis test were adopted to compare the difference of DNA damage repair, stemness and cell death between sensitive and resistant NPC cells. The biological functions of PCK2 were investigated by knocking down the endogenous PCK2 in vitro and in vivo. In addition, the tumor morphology and related markers were observed by HE staining and immunohistochemistry assay, respectively.

RESULTS

Intracellular PCK2 is transiently upregulated after a single irradiation in both SUNE-1 and 5-8 F cells. However, PCK2 was significantly reduced in radiation-tolerant cells that survived from multiple irradiations. Further work showed that PCK2 down-regulation prevented SUNE-1R and 5-8FR cells from IR-induced ferroptosis, accompanied by increased cell ability of DNA damaged repair and enhanced phenotypes of tumor stem cells.

CONCLUSIONS

Our findings indicate that low expression of PCK2 is an important phenotypic feature of radioresistant NPC cells. It could be a result of PCK2 involved in regulating radiation-induced ferroptosis. Regulating the expression of PCK2 may provide new strategies for improving NPC radiation sensitivity.

Financial toxicity-related factors in patients with nasopharyngeal carfcinoma: a cross-sectional study

PURPOSE

This cross-sectional study aimed to investigate the incidence and related factors of financial toxicity among nasopharyngeal carcinoma (NPC) patients and propose strategies for improvement.

METHODS

Patients with nasopharyngeal carcinoma were recruited from December 2022 to June 2023 in Changsha, Hunan Province, China, using convenience sampling. A questionnaire survey focusing on financial toxicity among patients with nasopharyngeal carcinoma was conducted. The assessment tools used in this study include Comprehensive Scores for Financial Toxicity Based on the Patient-Reported Outcome Measures (COST-PROM), Medical Coping Modes Questionnaire (MCMQ), and Perceived Social Support Scale (PSSS).

RESULTS

A total of 155 patients with nasopharyngeal carcinoma were included in the study. The incidence of financial toxicity among participants was found to be 65.8%, with an average COST score of 22.45 ± 7.91. A significant negative correlation was shown between MCMQ scores and financial toxicity in patients (r = -0.235, p = 0.003), while a significant positive correlation was demonstrated between the PSSS scores and financial toxicity (r = 0274, p = 0.001). The multiple linear regression analysis showed that personal monthly income, MCMQ scores, and PSSS scores were related to financial toxicity in patients with nasopharyngeal carcinoma.

CONCLUSION

This study revealed a high prevalence of financial toxicity in patients with nasopharyngeal carcinoma. The medical staff needs to identify the financial toxicity early and adopt appropriate strategies to help patients with nasopharyngeal carcinoma return to work, guide them to choose positive medical coping modes, and access more excellent social support.

Integrated network pharmacology, molecular docking and experimental validation to investigate the mechanism of tannic acid in nasopharyngeal cancer

Tannic acid (TA) is the primary bioactive component in the gallnut (Galla chinensis) and has exhibited the anticancer effects. However, the mechanism of its anti-cancer activity in nasopharyngeal carcinoma (NPC) remains unclear. This research aims to explore the underlying mechanism of TA in the treatment of nasopharyngeal cancer using network pharmacology, molecular docking and experimental validation. Firstly, the targets of TA and NPC were predicted and collected through databases, and the intersection targets were identified. Subsequently, protein-protein interaction (PPI) network analysis, Gene Ontology (GO) enrichment, Kyoto Encyclopedia of Genes Genomes (KEGG) pathway enrichment analysis, molecular docking and molecular dynamics (MD) simulation were conducted to uncover the potential mechanisms of TA in treatment of NPC. Finally, in vitro experiments were utilized to verify the mechanism of TA with anticancer activity in NPC. The results of network pharmacology revealed 42 intersection targets between NPC-related targets and TA-related targets. The phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) signaling was identified as the main target pathway of TA against NPC. Additionally, molecular docking and MD simulation confirmed the closely binding affinities of TA with AKT1. Furthermore, the results of in vitro experiments demonstrated that TA exerts anticancer activity against NPC by targeting the PI3K/AKT signaling pathway, leading to the suppression of cell proliferation. TA is a promising therapeutic candidate for NPC through PI3K/AKT signaling pathway. These results provide insights into the clinical application of TA, particularly when considered in combination with other therapeutic modalities.

Patterns of failure and prognosis in nasopharyngeal carcinoma according to Epstein-Barr virus DNA status

PURPOSE

To investigate the patterns of failure and prognosis in recurrent or metastatic nasopharyngeal carcinoma (rmNPC) according to Epstein-Barr virus-DNA (EBV-DNA) status.

METHODS

We included NPC patients who were diagnosed with locoregional recurrence (LRR) and/(or) distant metastasis (DM) between January 2017 and June 2024. Receiver operating characteristic analysis, Chi-square test, Wilcoxon rank sum test, Kaplan-Meier method, and Multivariate Cox regression analyses were used for statistical analysis.

RESULTS

This study involved 108 patients, including 105 (97.2%) who had EBV-DNA detectable at the initial diagnosis of NPC. Regarding progression patterns, 34 patients (31.5%) experienced only LRR, while 60 patients (55.6%) had only DM. LRR followed by DM was observed in 5 (4.6%) patients, DM followed by LRR occurred in 2 (1.8%) patients, and both LRR and DM were presented simultaneously in 7 (6.5%) patients. EBV-DNA positivity rates significantly differed between LRR and DM patients, at 76.9% and 97.1% respectively (P = 0.003). A significant difference was also observed in EBV-DNA levels, with a median level of 413 copies/mL for LRR and 6,550 copies/mL for DM (P < 0.001). While the EBV-DNA positivity rate did not differ significantly between oligometastatic disease and polymetastatic disease (P = 0.493), the levels were significantly elevated in the polymetastatic disease group than the oligometastatic disease group (P < 0.001). Multivariate analysis showed that liver metastasis (P = 0.012) and EBV-DNA levels ≥ 3,525 copies/mL at progression (P = 0.009) independently correlated with poorer overall survival.

CONCLUSIONS

Our study provides substantial evidence linking higher EBV-DNA levels with disease failure patterns and identifies liver metastasis and EBV-DNA levels at disease progression as independent prognostic factors for poorer overall survival in rmNPC patients.

Immune-related adverse events as prognostic biomarkers in recurrent or metastatic nasopharyngeal carcinoma receiving PD-L1 inhibitor: A post-hoc analysis of the multicenter, single-arm, phase 2 study

BACKGROUND

Immune-related adverse events (irAEs) have been associated with better therapeutic outcomes in patients receiving immune checkpoint inhibitors (ICIs) across various cancers. This study investigates the association between irAEs and ICI outcomes in patients with recurrent or metastatic nasopharyngeal carcinoma (R/M NPC).

METHODS

A post hoc analysis was performed on 153 patients with R/M NPC who received anti-PD-L1 inhibitors between February 26, 2019, and January 13, 2021. These patients were enrolled in a multicenter, single-arm, phase 2 clinical trial, which represents the largest study to date evaluating anti-PD-L1 therapy in previously treated R/M NPC.

RESULTS

Patients who experienced irAEs had significantly higher overall response rates (ORR) and diseade control rates (DCR) compared to those without irAEs (31.2 % vs. 17.1 %, p = 0.039; 66.7 % vs. 44.8 %, p = 0.017). Additionally, the median progression-free survival (PFS) was longer in patients with irAEs (129 days vs. 56 days, p = 0.007). Patients with endocrine-related irAEs exhibited higher DCR (71.8 % vs. 46.2 %, p = 0.012), and longer PFS (144 days vs. 69 days, p = 0.02) and overall survival (OS: 746 days vs. 438 days, p = 0.02). In contrast, patients with grade ≥ 3 irAEs or thoserequiring systemic steroid therapy had shorter median OS (179 days vs. 466 days, p = 0.03; 166 days vs. 462 days, p = 0.02).

CONCLUSIONS

The occurrence of irAEs, particularly those involving the endocrine system, is associated with enhanced efficacy of anti-PD-L1 therapy and extended survival in patients with R/M NPC, highlighting their potential as prognostic biomarkers.

EMC2 suppresses ferroptosis via regulating TFRC in nasopharyngeal carcinoma

BACKGROUND

Nasopharyngeal carcinoma (NPC) is an epithelial malignancy with poorly understood underlying molecular mechanisms. Ferroptosis, a form of programmed cell death, is not fully elucidated in NPC.

METHOD

We conducted quantitative proteomics to detect dysregulated proteins in NPC tissues. The levels of endoplasmic reticulum membrane protein complex 2 (EMC2) in NPC tissue microarrays were evaluated by immunohistochemistry, and the prognostic value of EMC2 was analyzed in NPC patients. The role of EMC2 in ferroptosis and carcinogenesis was determined through in vitro and in vivo experiments. Quantitative proteomics, protease inhibition, ubiquitin detection, and rescue experiments were performed to explore the mechanism of EMC2-regulated ferroptosis.

RESULTS

Significantly upregulated EMC2 was detected in NPC, and it was closely related to the characteristics of tumor progression. Elevated EMC2 was obviously correlated with poor survival in patients with NPC. EMC2 knockdown promoted ferroptosis, inhibiting cell viability, migration, and invasion, and enhancing the efficacy of cisplatin in NPC cells. Conversely, EMC2 overexpression contributed to ferroptosis repression, malignant progression, and reduced the efficacy of cisplatin. In addition, EMC2 knockdown suppressed xenograft tumor growth and enhanced ferroptosis in nude mice. Mechanistically, we identified transferrin receptor (TFRC) as a critical downstream protein. EMC2 interacted with TFRC and promoted its ubiquitin-proteasomal degradation. EMC2 regulated ferroptosis by mediating the level of TFRC.

CONCLUSIONS

EMC2 suppresses ferroptosis and promotes tumor progression, and the EMC2-TFRC axis is a novel ferroptosis regulatory pathway. EMC2 is a potentially biomarker and therapeutic target for NPC.

Comparative effectiveness and cost-effectiveness of endoscopic nasopharyngectomy versus intensity-modulated radiotherapy in the treatment of recurrent nasopharyngeal carcinoma: A microsimulation analysis

BACKGROUND

Nasopharyngeal carcinoma (NPC) is a significant health concern in southern China, like Guangdong and Hong Kong. This study aims to predict the effectiveness and cost-effectiveness of two prevalent NPC treatments, intensity-modulated radiotherapy (IMRT) and endoscopic nasopharyngectomy (ENPG).

METHODS

A microsimulation model was developed to project the long-term outcomes of IMRT and ENPG, simulating 5000 patients with hypothetical locally recurrent NPC for each treatment option. The tumors of patients confined to the nasopharyngeal cavity, the post-naris or nasal septum, the superficial parapharyngeal space, or the base wall of the sphenoid sinus. Analyses were performed from the healthcare system perspectives of Mainland China and the healthcare provider perspective of Hong Kong, with input parameters sourced from the existing literature and databases. The robustness of findings was evaluated through one-way and probabilistic sensitivity analyses.

RESULTS

For DFS, ENPG showed a 29% reduction in risk with an HR of 0.71 (95% CI: 0.64-0.77) compared to IMRT. ENPG demonstrated a significant survival benefit in OS with an HR of 0.59 (95% CI: 0.54-0.65), equating to a 41% reduction in mortality risk. In Hong Kong, IMRT and ENPG yielded QALY gains of 4.59 and 6.29, respectively, with ENPG exhibiting an incremental cost-effectiveness ratio (ICUR) of USD 13 057 per QALY. For Mainland China, ENPG denominated the IMRT and the ICUR was USD -1450 QALY. Probabilistic sensitivity analysis showed a 100% probability of ENPG being cost-effective at the willingness-to-pay thresholds of USD 130 490 per QALY in Hong Kong and USD 12 741 per QALY in Mainland China.

CONCLUSION

The analysis confirms that ENPG is more effective and cost-effective than IMRT for treating recurrent NPC in both Hong Kong and Mainland China.

Clinical and Genomic Phenotype of Brain Metastasis in Nasopharyngeal Carcinoma

Brain metastasis in nasopharyngeal carcinoma is a rare but poor prognosis clinical problem. This study aims to investigate the clinical characteristics and identify the genomic profiling of nasopharyngeal carcinoma brain metastasis. Patients with a diagnosis of nasopharyngeal carcinoma who visited at the Fifth Affiliated Hospital of Sun Yat-sen University since January 2013 to December 2023 were retrospectively collected. Clinical data of patients diagnosed with nasopharyngeal carcinoma brain metastasis were extracted. Paraffin blocks of NPC brain metastases were acquired for immunohistochemistry and genetic testing. High-throughput second generation sequencing was performed for genomic analysis. The mutation landscape was further analyzed. Of the 2378 NPC patients from our database, only six were clinically diagnosed with nasopharyngeal carcinoma brain metastasis. Three were pathologically diagnosed with nasopharyngeal carcinoma brain metastasis. The time interval from the first diagnosis of nasopharyngeal carcinoma to brain metastasis was 15-56 months. The common sites of brain metastasis were frontal lobe and cerebellum, and could be single or multiple, cystic or solid lesions. The OS ranged from 7 to 48 months. Single nucleotide variants were found in 32 genes, such as PTEN, TP53, NFKBIA, KMT2C, and NOTCH1. Copy number variation occurred in five genes, including PTEN, CCDN1, FGF19, FGF3 and FGF4. PTEN and fibroblast growth factors might be involved in the molecular regulation of brain metastasis in nasopharyngeal carcinoma.

Hsa-miR-92b-3p Targeting FHL2 to Enhance Radiosensitivity of Nasopharyngeal Carcinoma

Radiotherapy resistance is a major cause of treatment failure and leads to poor prognosis in nasopharyngeal carcinoma (NPC). Evidences indicate that microRNA (miRNAs) are closely associated with radiotherapy for NPC. In this study, we found that the expression level of miR-92b-3p was significantly higher in radiotherapy-sensitive NPC patients than in radiotherapy-resistant patients. High expression of miR-92b-3p was associated with good prognosis in patients with NPC, and high expression of FHL2 was associated with poor prognosis in patients with NPC. It was predicted that miR-92b-3p could directly target and bind FHL2. Overexpression of miR-92b-3p significantly inhibited FHL2 expression at the mRNA as well as protein levels, while inhibition of miR-92b-3p expression significantly upregulated FHL2 expression. Overexpression of miR-92b-3p significantly reduced proliferation and colony formation in NPC cells. Inhibition of miR-92b-3p attenuated the sensitivity of nasopharyngeal carcinoma to radiotherapy, while simultaneous inhibition of miR-92b-3p and FHL2 increased the sensitivity of NPC to radiotherapy. Our findings highlighted that miR-92b-3p is closely associated with radiotherapy sensitivity and prognosis in NPC patients and may improve the sensitivity of NPC to radiotherapy by targeting FHL2.

tsRNA in head and neck tumors: Opportunities and challenges in the field

Transfer RNA-derived small RNAs (tsRNAs) are a newly recognized class of small non-coding RNAs that are implicated in a variety of cancers, including head and neck tumors. Studies have identified tsRNAs with differential expression profiles in head and neck malignancies, highlighting their potential as biomarkers for diagnosis and prognosis. Functional analyses show that tsRNAs are involved in regulating critical cellular pathways, including those related to cell proliferation, migration, and metabolic processes. Despite these encouraging insights, there are myriad challenges that must be tackled. In summary, tsRNAs present considerable potential as therapeutic targets and biomarkers in the realm of head and neck tumors, meriting further investigation and clinical application to optimize outcomes in the management of these complex diseases. This literature review synthesizes current research on tsRNAs, tsRNAs hold significant promise as biomarkers and therapeutic targets, with the potential to transform diagnostic and treatment strategies for head and neck tumors, ultimately improving patient outcomes.

Efficacy of radiotherapy in treating local recurrence concomitant with distant metastasis of nasopharyngeal carcinoma: a long-term retrospective multicenter study

PURPOSE

Patients with nasopharyngeal carcinoma (NPC) experiencing locoregional recurrence concomitant with distant metastases (rmNPC) after initial treatment represent a unique subgroup with significant management challenges. This study aimed to evaluate overall survival (OS) in rmNPC patients treated with systemic therapies with or without radiotherapy.

METHODS

This retrospective multicenter study included patients with locally recurrent and metastatic NPC from five hospitals. Kaplan-Meier analyses and log-rank tests were applied to assess survival outcomes based on recurrence and metastasis profiles, as well as treatment modalities. Independent prognostic factors affecting OS were identified using Cox regression models.

RESULTS

A total of 52 patients were analyzed, with a median follow-up duration of 68.3 months (range: 7-240 months). The median OS was 23.4 months (range: 11.1-35.6 months), and the 1-, 2-, 3-, 4-, and 5-year OS rates were 61.3%, 46.5%, 31.0%, 27.9%, and 10.5%, respectively. The treatment modality did not significantly affect OS overall (P = 0.071). Median OS was 10.8 months (95% CI, 7.7-13.9) for chemotherapy alone, 24.2 months (95% CI, 8.9-39.4) for chemotherapy combined with PD-1 inhibitors, and 47.1 months (95% CI, 10.2-84.0) for chemotherapy combined with radiotherapy. In patients with oligometastasis, radiotherapy significantly improved OS (50.1 vs. 24.1 months, P = 0.021), whereas no significant OS benefit was observed for radiotherapy in polymetastatic patients (8.6 vs. 14.8 months, P = 0.168). Similarly, radiotherapy extended OS in patients with one-organ metastases (50.1 vs. 24.1 months, P = 0.026), while no significant benefit was observed in those with multiple-organ metastases (8.6 vs. 11.0 months, P = 0.831).

CONCLUSIONS

Radiotherapy, when combined with other treatment modalities, significantly improves OS in rmNPC patients with oligometastases or one-organ metastases.

Impact of Clinical Surveillance on Outcomes of Locally Recurrent Nasopharyngeal Carcinoma

BACKGROUND

Local recurrence of nasopharyngeal carcinoma (NPC) occurs in 10%-20% of patients, with salvage potential in early recurrences. Yet, clear surveillance protocols are lacking. We compare survival outcomes and suitability for salvage in symptomatic and incidentally detected locally recurrent NPC.

METHODS

Locally recurrent NPC patients, initially diagnosed at the National Cancer Center Singapore between October 2003 and November 2009, were identified. Demographics, symptoms, detection modalities, and survival outcomes were analyzed.

RESULTS

Eighty-two patients were studied. Median follow up and time to local recurrence was 5.51 and 2.19 years; 45.1% were symptomatic; 65.9% were diagnosed incidentally; 62.2% were offered salvage treatment. Symptomatic patients (vs. asymptomatic) had lower 5-year overall-survival (39.1% vs. 74.5%, p = 0.011). Nonincidental diagnoses (vs. incidental) had lower 5-year overall-survival (33.6% vs. 71.1%, p = 0.02). Incidentally-detected recurrences (vs. nonincidental) were more likely offered salvage treatment (75.9% vs. 35.7%, p < 0.001).

CONCLUSION

Routine clinical examination, nasoendoscopy, and imaging allow early detection of asymptomatic recurrences, with improved outcomes.

Exploring the influence of age on the causes of death in advanced nasopharyngeal carcinoma patients undergoing chemoradiotherapy using machine learning methods

The present study analyzed the impact of age on the causes of death (CODs) in patients with nasopharyngeal carcinoma (NPC) undergoing chemoradiotherapy (CRT) using machine learning approaches. A total of 2841 patients (1037 classified as older, ≥ 60 years and 1804 as younger, < 60 years) were enrolled. Variations in the CODs between the two age groups were analyzed before and after applying inverse probability of treatment weighting (IPTW). Additionally, seven different machine learning models were employed as predictive tools to identify key variables and assess the therapeutic outcomes in NPC patients receiving CRT. The younger group exhibited a significantly longer overall survival (OS) than the older group, both before the IPTW adjustment (140 vs. 50 months, P < 0.001) and after the adjustment (137 vs. 53 months, P < 0.001). After IPTW, the older group was associated with worse 5-, 10-, and 15-year cumulative incidences in terms of NPC-related deaths (30, 34, and 38% vs. 21, 27, and 30%; P < 0.001), cardiovascular disease (CVD; 4.1, 7.2, and 8.8% vs. 0.5, 1.8, and 3.0%; P < 0.001), and other causes (8.3, 17, and 24% vs. 4.1, 8.7, and 12%; P < 0.001). However, cumulative incidences of secondary malignant neoplasms were comparable between the two groups (P = 0.100). The random forest (RF) model demonstrated the highest concordance index of 0.701 among all models. Time-dependent variable importance plots indicated that age was the most influential factor affecting 3-, 5-, and 10-year survival, followed by metastasis and tumor stage. Younger patients had significantly longer OS than their older counterparts. Older patients had a higher likelihood of dying from non-NPC-related causes, particularly CVDs. The RF model showed the best predictive accuracy, identifying age as the most critical factor influencing OS in NPC patients undergoing CRT.

METTL3 methylated KIF15 promotes nasopharyngeal carcinoma progression and radiation resistance by blocking ATG7-mediated autophagy through the activation of STAT3 pathway

BACKGROUND

Resistance to radiotherapy is a major component in the failure of nasopharyngeal carcinoma (NPC) treatment. Enhancing autophagy in nasopharyngeal carcinoma may increase its radiation sensitivity, making it critical to find autophagy-modulating targets.

METHODS

The level of KIF15 was determined in NPC patients. Then, radiation-resistant NPC cells were produced to explore the mechanism in NPC. KIF15 was suppressed, and cell function and autophagy-related variables were examined in radiation-resistant NPC cells. Then the autophagy pathway was blocked, and the link between KIF15 and autophagy was confirmed. Finally, an NPC murine model was established, with tumors implanted in aberrant sites, and the relationship discovered at the cell level was confirmed in vivo. All statistical significance was determined using the student's t-test and one-way ANOVA.

RESULTS

Elevated amounts of KIF15 were discovered to be significantly expressed in NPC tissues and played a role in the radioresistance of NPC, a phenomenon attributed to METTL3-mediated m6A methylation. Blocking KIF15 resulted in decreased cell proliferation, increased cell death, and the activation of autophagy, ultimately making NPC more sensitive to radiation. This also resulted in decreased tumor development and increased levels of autophagy and apoptosis in vivo KIF15 interacted with STAT3, retaining it in the cytoplasm. Overexpression of STAT3 reversed the inhibitory effects of KIF15 knockdown on NPC and also reversed the influence of sh-KIF15 on autophagy activation. Inhibition of KIF15 decreased the inhibitory effect of STAT3 on ATG7, thereby upregulating autophagy activation in radio-resistant NPC cells.

CONCLUSION

The increased expression of KIF15 was found to be associated with the progression of NPC and play a role in the development of radioresistance in NPC. Inhibiting KIF15 was shown to impede tumor growth and improve the sensitivity of NPC to radiotherapy by triggering autophagy via the STAT3/ATG7 pathway.

M6A-mediated molecular patterns and tumor microenvironment infiltration characterization in nasopharyngeal carcinoma

N6-methyladenosine (m6A) is the most predominant RNA epigenetic regulation in eukaryotic cells. Numerous evidence revealed that m6A modification exerts a crucial role in the regulation of tumor microenvironment (TME) cell infiltration in several tumors. Nevertheless, the potential role and mechanism of m6A modification in nasopharyngeal carcinoma (NPC) remains unknown. mRNA expression data and clinical information from GSE102349, and GSE53819 datasets obtained from Gene Expression Omnibus (GEO) was used for differential gene expression and subsequent analysis. Consensus clustering was used to identify m6A-related molecular patterns of 88 NPC samples based on prognostic m6A regulators using Univariate Cox analysis. The TME cell-infiltrating characteristics of each m6A-related subclass were explored using single-sample gene set enrichment (ssGSEA) algorithm and CIBERSORT algotithm. DEGs between two m6A-related subclasses were screened using edgeR package. The prognostic signature and predicated nomogram were constructed based on the m6A-related DEGs. The cell infiltration and expression of prognostic signature in NPC was determined using immunohistochemistry (IHC) analysis. Chi-square test was used to analysis the significance of difference of the categorical variables. And survival analysis was performed using Kaplan-Meier plots and log-rank tests. The NPC samples were divided into two m6A-related subclasses. The TME cell-infiltrating characteristics analyses indicated that cluster 1 is characterized by immune-related and metabolism pathways activation, better response to anit-PD1 and anti-CTLA4 treatment and chemotherapy. And cluster 2 is characterized by stromal activation, low expression of HLA family and immune checkpoints, and a worse response to anti-PD1 and anti-CTLA4 treatment and chemotherapy. Furthermore, we identified 1558 DEGs between two m6A-related subclasses and constructed prognostic signatures to predicate the progression-free survival (PFS) for NPC patients. Compared to non-tumor samples, REEP2, TMSB15A, DSEL, and ID4 were upregulated in NPC samples. High expression of REEP2 and TMSB15A showed poor survival in NPC patients. The interaction between REEP2, TMSB15A, DSEL, ID4, and m6A regulators was detected. Our finding indicated that m6A modification plays an important role in the regulation of TME heterogeneity and complexity.

Lung immune prognostic index is associated with clinical outcomes in recurrent or metastatic (R/M) nasopharyngeal carcinoma receiving immunotherapy: Results from the multicenter, single-arm, phase 2 study

BACKGROUND

Immune-related biomarkers are linked to the outcomes of cancer immunotherapy. This study evaluates the baseline and longitudinal association between the lung immune prognostic index (LIPI) and immune checkpoint inhibitor outcomes in previously treated recurrent or metastatic (R/M) nasopharyngeal carcinoma (NPC) patients.

METHODS

Data from 153 R/M NPC patients (median age = 49.00 years old) enrolled in a multicenter, single-arm, phase 2 study (NCT03848286) were analyzed. Pretreatment LIPI was classified into good and intermediate/poor (inter/poor) groups. Longitudinal LIPI variations were categorized into "Stable good", "Trend to increase", "Trend to decrease", and "Stable inter/poor". Primary and secondary outcomes were overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR).

RESULTS

Pretreatment LIPI was significantly associated with OS (inter/poor vs. good: HR = 2.54, 95 % CI: 1.60-4.04, P < 0.001), PFS [inter/poor vs. good: hazard ratio (HR) = 2.18, 95 % CI: 1.47-3.23, P < 0.001], and DCR [inter/poor vs. good: odd ratio (OR) = 0.26, 95 % CI: 0.12-0.58, P < 0.001)]. Patients with persistently inter/poor LIPI status showed worse OS (HR = 3.25, 95 % CI: 1.84-5.74, P < 0.001), PFS (HR = 2.96, 95 % CI: 1.85-4.74, P < 0.001), and ORR (OR = 0.21, 95 % CI: 0.08-0.56, P < 0.001) compared to the persistently good subgroup.

CONCLUSION

Pretreatment LIPI and its longitudinal variations may serve as potential biomarkers for predicting immune checkpoint inhibitor outcomes in R/M NPC patients.

International Recommendations on Postoperative Management for Potentially Resectable Locally Recurrent Nasopharyngeal Carcinoma

Locally recurrent nasopharyngeal carcinoma (NPC) presents substantial challenges in clinical management. Although postoperative re-irradiation (re-RT) has been acknowledged as a potential treatment option, standardized guidelines and consensus regarding the use of re-RT in this context are lacking. This article provides a comprehensive review and summary of international recommendations on postoperative management for potentially resectable locally recurrent NPC, with a special focus on postoperative re-RT. A thorough search was conducted to identify relevant studies on postoperative re-RT for locally recurrent NPC. Controversial issues, including resectability criteria, margin assessment, indications for postoperative re-RT, and the optimal dose and method of re-RT, were addressed through a Delphi consensus process. The consensus recommendations emphasize the need for a clearer and broader definition of resectability, highlighting the importance of achieving clear surgical margins, preferably through an en bloc approach with frozen section margin assessment. Furthermore, these guidelines suggest considering re-RT for patients with positive or close margins. Optimal postoperative re-RT doses typically range around 60 Gy, and hyperfractionation has shown promise in reducing toxicity. These guidelines aim to assist clinicians in making evidence-based decisions and improving patient outcomes in the management of potentially resectable locally recurrent NPC. By addressing key areas of controversy and providing recommendations on resectability, margin assessment, and re-RT parameters, these guidelines serve as a valuable resource for clinical experts involved in the treatment of locally recurrent NPC.

Radiation-induced nasopharyngeal necrosis combined with local recurrence in nasopharyngeal carcinoma: diagnosis and treatment strategies

BACKGROUND

To identify the diagnosis and treatment strategies by analyzing the clinical characteristics and treatment methods of RNNCLR.

METHODS

A total of 210 patients pathologically diagnosed with RNNCLR were retrospectively included. Clinical characteristics, MRI features, treatment methods, and survival outcomes were analyzed. Propensity score matching (PSM) analysis was performed to adjust the surgical benefit.

RESULTS

Ninety-one patients (43.3%) took a single biopsy, 67 patients (31.9%) underwent repeated biopsies and 52 patients (24.8%) received endoscopic surgery to obtain pathological positive tissues. RNNCLR had characteristic imaging features distinguished from pure radiation necrosis. The interval from the previous radiotherapy was 13.2 (7.0, 23.3) months. The 1-year, 3-year, and 5-year overall survival rates were 59.6%, 32.3%, and 14.6%. Patients with reirradiation, detectable EBV-DNA level, or ICA exposure had a worse prognosis. Overall survival was significantly higher in the endoscopic surgery group than in nonsurgery group after PSM (3-year OS rates, 44.5% vs. 23.9%, p = 0.011).

CONCLUSIONS

Histopathological diagnosis of RNNCLR needs repeated biopsies or even surgery. Careful analysis of MRI images, correlation with interval time from last radiation, and short-term follow-up may solve the diagnostic dilemmas. Endoscopic surgery results in a survival benefit by completely resecting lesions or removing necrotic tissue to reduce necrosis-related complications.

A clinical-radiomics nomogram based on multisequence MRI for predicting the outcome of patients with advanced nasopharyngeal carcinoma receiving chemoradiotherapy

Problem

Nasopharyngeal carcinoma (NPC) is a common malignant tumor with high heterogeneity and is mainly treated with chemoradiotherapy. It is important to predict the outcome of patients with advanced NPC after chemoradiotherapy to devise customized treatment strategies. Traditional MRI methods have limited predictive power, and better predictive models are needed.

Aim

To evaluate the predictive value of a clinical-radiomics nomogram based on multisequence MRI in predicting the outcome of advanced NPC patients receiving chemoradiotherapy.

Methods

This prospective study included a retrospective analysis of 118 patients with advanced NPC who underwent MRI prior to chemoradiotherapy. The primary endpoint was progression-free survival (PFS). The maximum ROIs of lesions at the same level were determined via axial T2-weighted imaging short-time inversion recovery (T2WI-STIR), contrast-enhanced T1-weighted imaging (CE-T1WI), and diffusion-weighted imaging (DWI) with solid tumor components, and the radiomic features were extracted. After feature selection, the radiomics score was calculated, and a nomogram was constructed combining the radiomics score with the clinical features. The diagnostic efficacy of the model was evaluated by the area under the receiver operating characteristic curve (AUC), and the clinical application value of the nomogram was evaluated by decision curve analysis (DCA) and a correction curve. Patients were divided into a high-risk group and a low-risk group, and the median risk score calculated by the joint prediction model was used as the cutoff value. Kaplan-Meier analysis and the log-rank test were used to compare the differences in survival curves between the two groups.

Results

The AUCs of the nomogram model constructed by the combination of the radiomics score and neutrophil-to-lymphocyte ratio (NLR) and T stage in the training group and validation group were 0.897 (95% CI: 0.825-0.968) and 0.801 (95% CI: 0.673-0.929), respectively. Kaplan-Meier survival analysis demonstrated that the model effectively stratified patients into high- and low-risk groups, with significant differences in prognosis.

Conclusion

This clinical-radiomics nomogram based on multisequence MRI offers a noninvasive, effective tool for predicting the outcome of advanced NPC patients receiving chemoradiotherapy, promoting individualized treatment approaches.

Salvage Endoscopic Nasopharyngectomy for Recurrent Nasopharyngeal Cancer: an Institutional Experience

Objective

This study aims to present the surgical and oncological long-term outcomes of patients with locally recurrent nasopharyngeal cancer (NPC) following endoscopic endonasal nasopharyngectomy (EEN).

Methods

The medical records of 11 patients who underwent EEN due to recurrent NPC were retrospectively reviewed.

Results

The mean age of the patient cohort, consisting of 10 males (90.9%) and one female (9.1%), was 44±13.01 years at the time of initial diagnosis. Seven patients (63.7%) had local recurrence, and four patients (36.3%) had loco-regional recurrence. The mean time to first recurrence from the initial diagnosis was 40.3 months, with a 5-year overall survival (OS) rate of 72.7% and a disease-free survival (DFS) rate of 27.3%. There were no significant differences between the concurrent chemoradiotherapy (CRT) and induction chemotherapy+concurrent CRT treatment groups in terms of DFS and OS as a first-line treatment (p=0.645).

Conclusion

EEN is a viable alternative approach for selected cases of locally recurrent NPC, considering the morbidities associated with re-irradiation.

Research landscape of radiotherapy for nasopharyngeal carcinoma from 1959 to 2022: A bibliometric analysis

Background

Radiotherapy, as the main treatment method for nasopharyngeal carcinoma (NPC), has evolved over time, but there has been no bibliometric study on NPC radiotherapy to date. In our study, the scientific achievements of NPC radiotherapy around the world were evaluated by bibliometric analyses, and the previous research hotspots and future trends are described.

Methods

Original articles related to NPC radiotherapy were obtained from the Web of Science Core Collection. To identify research hotspots and future trends, countries/regions, institutions, journals, references, authors, and keywords were evaluated and visualized by Excel, VOSviewer, and CiteSpace.

Results

From 1959 to 2022, 7139 original articles were collected. The annual publications showed an increasing trend, especially after 2011. China had the most publications (n = 3719, 52.09 %). Sun Yat-sen University has the most publications and citations among institutions. Jun Ma is most productive and SR Baker has the highest co-cited centrality. International Journal of Radiation Oncology-Biology-Physics is the core journal, with most publications, citations and co-citations. Analysis of keywords showed intensity-modulated radiotherapy and chemoradiotherapy were the main keywords, and multicenter showed the strongest burst.

Conclusion

NPC radiotherapy has attracted increasing attention, and precision and artificial intelligence may be the future trends in this field.

LncRNA HOTAIRM1 promotes radioresistance in nasopharyngeal carcinoma by modulating FTO acetylation-dependent alternative splicing of CD44

BACKGROUND

Radiotherapy is the primary treatment for patients with nasopharyngeal carcinoma (NPC); however, almost 20% of patients experience treatment failure due to radioresistance. Therefore, understanding the mechanisms of radioresistance is imperative. HOTAIRM1 is deregulated in various human cancers, yet its role in NPC radioresistance are largely unclear.

METHODS

This study investigated the association between HOTAIRM1 and radioresistance using CCK8, flow cytometry, and comet assays. Additionally, xenograft mice and patient-derived xenografts (PDX) models were employed to elucidate the biological functions of HOTAIRM1, and transcriptomic RNA sequencing was utilized to identify its target genes.

RESULTS

Our study revealed an upregulation of HOTAIRM1 levels in radioresistant NPC cell lines and tissues. Furthermore, a positive correlation was noted between high HOTAIRM1 expression and increased NPC cell proliferation, reduced apoptosis, G2/M cell cycle arrest, and diminished cellular DNA damage following radiotherapy. HOTAIRM1 modulates the acetylation and stability of the FTO protein, and inhibiting FTO elevates the m6A methylation level of CD44 precursor transcripts in NPC cells. Additionally, silencing the m6A reading protein YTHDC1 was found to increase the expression of CD44V. HOTAIRM1 enhances NPC cell resistance to ferroptosis and irradiation through the HOTAIRM1-FTO-YTHDC1-CD44 axis. Mechanistically, HOTAIRM1 interacts with the FTO protein and induces m6A demethylation of the CD44 transcript. The absence of m6A modification in the CD44 transcript prevents its recognition by YTHDC1, resulting in the transition from CD44S to CD44V. An abundance of CD44V suppresses ferroptosis induced by irradiation and contributes to NPC radioresistance.

CONCLUSIONS

In conclusion, the results in this study support the idea that HOTAIRM1 stimulates CD44 alternative splicing via FTO-mediated demethylation, thereby attenuating ferroptosis induced by irradiation and promoting NPC radioresistance.

PLUNC inhibits invasion and metastasis in nasopharyngeal carcinoma by inhibiting NLRP3 inflammasome activation

Nasopharyngeal carcinoma (NPC) is a malignant tumor that occurs in the nasopharynx. Palate, lung, and nasal epithelium clone (PLUNC) has been identified as an early secreted protein that is specifically expressed in the nasopharynx. The aim of this study was to determine the role and mechanism of PLUNC in NPC. We used mRNA sequencing (seq) combined with ribosome-nascent chain complex (RNC)-seq to determine the biological role of PLUNC. The expression of epithelial-to-mesenchymal transition (EMT)-related molecules was detected by western blotting. Then, cell migration and invasion were detected by wound healing and Transwell chamber assays. NPC cells were injected into the tail vein of nude mice to explore the biological role of PLUNC in vivo. The sequencing results showed that PLUNC inhibited the progression of NPC and its expression was correlated with that of NOD-like receptors. Experiments confirmed that PLUNC inhibited the invasion and metastasis of NPC cells by promoting the ubiquitination degradation of NLRP3. PLUNC overexpression in combination with the treatment by MCC950, an inhibitor of NLRP3 inflammasome activation, was most effective in inhibiting NPC invasion and metastasis. In vivo experiments also confirmed that the combination of PLUNC overexpression and MCC950 treatment effectively inhibited the lung metastasis of NPC cells. In summary, our research suggested that PLUNC inhibited the invasion and metastasis of NPC by inhibiting NLRP3 inflammasome activation, and targeting the PLUNC-NLRP3 inflammasome axis could provide a new strategy for the diagnosis and treatment of NPC patients.

Dual role of targeting NAE1 in nasopharyngeal carcinoma: Antitumor effects yet inducing radiotherapy resistance

Background and objectives

The inhibitor MLN4924 of Neural Precursor Cell-Expressed Developmentally Down-Regulated 8 (NEDD8) Activating Enzyme 1 (NAE1) has been found to suppress the growth of nasopharyngeal carcinoma (NPC). However, its effect on NPC's radiotherapy sensitivity remains unclear.

Methods

By integrating single-cell RNA sequencing and bulk RNA sequencing, we predict the impact of NAE1 on the cell cycle, cell death, and its relationship with radiotherapy sensitivity and prognosis in NPC. The effect of inhibiting NAE1 on NPC cell behavior and radiation sensitivity is explored through MLN4924 intervention in vitro and in vivo. We construct a prognosis prediction model based on NAE1 using machine learning methods and validate the efficacy of NAE1 and the model in clinical cohorts.

Results

NPC patients with high NAE1 expression have better prognosis and higher expression in the radiotherapy-sensitive group. Inhibiting NAE1 with MLN4924 causes cell cycle arrest in NPC cells, preventing them from entering the G2/M phase, thereby inhibiting proliferation but not affecting migration and metastasis. However, in vitro and in vivo experiments demonstrate that inhibiting NAE1 with MLN4924 leads to increased resistance of NPC to radiation.

Conclusions

Targeting NAE1 for NPC treatment may have dual effects, inhibiting NPC proliferation while also increasing radiation resistance.

A head-to-head comparison of [68Ga]Ga-DOTATATE and [68Ga]Ga-FAPI PET/CT in patients with nasopharyngeal carcinoma: a single-center, prospective study

PURPOSE

We aimed to compare the staging efficiency of [68Ga]Ga-DOTATATE and [68Ga]Ga-FAPI PET/CT in nasopharyngeal carcinoma (NPC) patients.

METHODS

Thirty-nine patients with pathologically confirmed NPC were enrolled in this prospective study. Each patient underwent paired [68Ga]Ga-DOTATATE and [68Ga]Ga-FAPI PET/CT on 2 successive days. The accuracy of two PET/CT for assessing T, N, and M stages was compared by using head-and-neck MRI, histopathologic diagnosis and follow-up results as reference standards. The radiotracer uptake derived from two PETs was also compared.

RESULTS

For treatment-naïve patients, [68Ga]Ga-DOTATATE PET/CT showed identical sensitivity for the primary tumours but clearer tumor delineation induced by higher tumour-to-background (TBR) ratio (19.1 ± 8.7 vs. 12.4 ± 7.7, P = 0.003), compared with [68Ga]Ga-FAPI PET/CT. Regarding cervical lymph node (CLN) metastases, [68Ga]Ga-DOTATATE PET had significantly better sensitivity and accuracy based on neck sides (98% vs. 82%, P < 0.001; 99% vs. 88% P = 0.008), neck levels (98% vs. 78%, 99% vs. 97%; both P < 0.001) and individual nodes (89% vs. 56%, 91% vs. 76%; both P < 0.001), and higher TBR (8.1 ± 4.1 vs. 6.3 ± 3.7, P < 0.001). Additionally, [68Ga]Ga-DOTATATE PET/CT revealed higher sensitivity and accuracy for distant metastases (96% vs. 53%, 95% vs. 52%; both P < 0.001), particularly in bone metastases (99% vs. 49%, 97% vs. 49%; both P < 0.001). For post-treatment patients, [68Ga]Ga-DOTATATE PET/CT identified one more true-negative case than [68Ga]Ga-FAPI PET/CT.

CONCLUSION

[68Ga]Ga-DOTATATE PET/CT performed better than [68Ga]Ga-FAPI PET/CT in visualizing the primary tumours, detecting the metastatic lesions and identifying the local recurrence, suggesting [68Ga]Ga-DOTATATE PET/CT may be superior to [68Ga]Ga-FAPI PET/CT for NPC staging.

Metabolic reprogramming in the pathogenesis and progression of nasopharyngeal carcinoma: molecular mechanisms and therapeutic implications

Nasopharyngeal carcinoma (NPC) is a unique head and neck cancer with a complex etiology involving genetic predispositions, environmental factors, and Epstein-Barr virus (EBV) infection. Despite progress in radiotherapy and chemotherapy, the prognosis for advanced NPC is still unfavorable, prompting the need for innovative therapeutic approaches. Metabolic reprogramming plays a crucial role in the development and progression of NPC, marked by substantial changes in glycolysis, lipid, and amino acid metabolism. These alterations aid tumor cell proliferation, survival under stress, and immune evasion, with features such as enhanced aerobic glycolysis (Warburg effect) and shifts in lipid and amino acid pathways. Oncogenic drivers like MYC, RAS, EGFR, and the loss of tumor suppressors such as TP53 and PTEN, along with key signaling pathways including mTOR, AMPK, and HIF-1α, orchestrate these metabolic changes. This review discusses the molecular mechanisms of metabolic reprogramming in NPC and outlines potential therapeutic targets within these pathways. Advances in metabolic imaging and biomarker discovery are also enhancing the precision of diagnostics and treatment monitoring, fostering personalized medicine in NPC treatment. This manuscript aims to provide a detailed overview of the current research and its implications for improving NPC management and patient outcomes through targeted metabolic therapies.

Case report: intracranial lesions in a patient with anxiety and depression: tumor recurrence or radiation encephalopathy?

Purpose

Radiation encephalopathy (REP) is one of the most common complications of radiotherapy for malignant tumors of the head and neck. Symptoms usually appear months to years following radiotherapy, with headache, insomnia, and memory loss as the main clinical features. We report a patient who was admitted to the hospital with anxiety and depressive disorder and was eventually diagnosed with REP.

Patients and methods

A 48-year-old patient who had undergone over 2 years of radiotherapy for nasopharyngeal carcinoma was admitted to the Department of Psychosomatic Medicine of our hospital because of recurrent fear, low mood, and waking up from dreams. Magnetic resonance imaging (MRI) revealed a mass in the left temporal lobe with a large peripheral edema. After multidisciplinary consultation, the possibility of tumor recurrence could not be excluded.

Results

Resection of the lesioned brain tissue to obtain pathological tissue showed glial cell proliferation and small focal areas of degeneration and necrosis, which indicated that the lesions were inflammatory. Postoperative MRI showed no abnormal signal, and the patient's condition improved.

Conclusion

Nasopharyngeal carcinoma patients with a history of radiotherapy and symptoms of increased intracranial pressure and neurological damage should be examined for REP. Furthermore, patients may experience anxiety and depressive disorders as a result of temporal lobe damage caused by REP.

Failure patterns and individualized treatment plans of reirradiation for inoperable locally recurrent nasopharyngeal carcinoma

Re-irradiation with intensity-modulated radiotherapy (IMRT) remains the primary treatment modality for inoperable locally recurrent nasopharyngeal carcinoma (NPC). However, the rate of radiation-related late adverse effects is often substantially high. Therefore, we aimed to explore failure patterns and individualized treatment plans of re-irradiation for inoperable locally recurrent NPC. Ninety-seven patients who underwent IMRT were retrospectively analyzed. Sixty-two patients had clinical target volume of recurrence (rCTV) delineated, and thirty-five patients had only gross tumor volume of recurrence (rGTV) delineated. Twenty-nine patients developed second local failures after re-irradiation with IMRT (28 cases available). Among those patients, 64.3% (18/28) of patients and 35.7% (10/28) developed in-field or out-field, respectively. No statistical correlation was observed between target volume (rGTV or rCTV) and the local recurrence rate, local failure patterns, grade ≥ 3 toxicity, and survival. Multivariate analysis showed that recurrent T (rT) stage (HR 2.62, P = 0.019) and rGTV volume (HR 1.73, P = 0.037) were independent prognostic factors for overall survival (OS). Risk stratification based on rT stage and rGTV volume revealed that low risk group had a longer 3-year OS rate (66.7% vs. 23.4%), lower total grade ≥ 3 toxicity (P = 0.004), and lower re-radiation associated mortality rates (HR 0.45, P = 0.03) than high risk group. This study demonstrates that the delineation of rCTV may not be beneficial for re-irradiation using IMRT in locally recurrent NPC. Patients with low risk were most suitable for re-irradiation, with maximizing local salvage and minimizing radiation-related toxicities. More precise and individualized plans of re-irradiation are warranted.

Radiomic signatures associated with tumor immune heterogeneity predict survival in locally recurrent nasopharyngeal carcinoma

BACKGROUND

The prognostic value of traditional clinical indicators for locally recurrent nasopharyngeal carcinoma is limited because of their inability to reflect intratumor heterogeneity. We aimed to develop a radiomic signature to reveal tumor immune heterogeneity and predict survival in locally recurrent nasopharyngeal carcinoma.

METHODS

This multicenter, retrospective study included 921 patients with locally recurrent nasopharyngeal carcinoma. A machine learning signature and nomogram based on pretreatment magnetic resonance imaging features were developed for predicting overall survival in a training cohort and validated in 2 independent cohorts. A clinical nomogram and an integrated nomogram were constructed for comparison. Nomogram performance was evaluated by concordance index and receiver operating characteristic curve analysis. Accordingly, patients were classified into risk groups. The biological characteristics and immune infiltration of the signature were explored by RNA-sequencing analysis.

RESULTS

The machine learning signature and nomogram demonstrated comparable prognostic ability to a clinical nomogram, achieving concordance indexes of 0.729, 0.718, and 0.731 in the training, internal, and external validation cohorts, respectively. Integration of the signature and clinical variables statistically improved the predictive performance. The proposed signature effectively distinguished patients between risk groups with statistically distinct overall survival rates. Subgroup analysis indicated the recommendation of local salvage treatments for low-risk patients. Exploratory RNA-sequencing analysis revealed differences in interferon response and lymphocyte infiltration between risk groups.

CONCLUSIONS

A magnetic resonance imaging-based radiomic signature predicted overall survival more accurately. The proposed signature associated with tumor immune heterogeneity may serve as a valuable tool to facilitate prognostic stratification and guide individualized management for locally recurrent nasopharyngeal carcinoma patients.

Isoliquiritigenin diminishes invasiveness of human nasopharyngeal carcinoma cells associating with inhibition of MMP-2 expression and STAT3 signalling

Nasopharyngeal carcinoma (NPC) is prevalent in Asia and exhibits highly metastatic characteristics, leading to uncontrolled disease progression. Isoliquiritigenin (ISL) have attracted attention due to their diverse biological and pharmacological properties, including anticancer activities. However, the impact of ISL on the invasive and migratory ability of NPC remains poorly understood. Hence, this study aimed to investigate the in vitro anti-metastatic effects of ISL on NPC cells and elucidate the underlying signalling pathways. Human NPC cell NPC-39 and NPC-BM were utilized as cell models. Migratory and invasive capabilities were evaluated through wound healing and invasion assays, respectively. Gelatin zymography was employed to demonstrate matrix metalloproteinase-2 (MMP-2) activity, while western blotting was conducted to analyse protein expression levels and explore signalling cascades. Overexpression of signal transducer and activator of transcription 3 (STAT3) was carried out by transduction of STAT3-expressing vector. Our findings revealed that ISL effectively suppressed the migration and invasion of NPC cells. Gelatin zymography and Western blotting assays demonstrated that ISL treatment led to a reduction in MMP-2 enzyme activity and protein expression. Investigation of signalling cascades revealed that ISL treatment resulted in the inhibition of STAT3 phosphorylation. Moreover, overexpression of STAT3 restored the migratory ability of NPC cells in the presence of ISL. Collectively, these findings indicate that ISL inhibits the migration and invasion of NPC cells associating with MMP-2 downregulation through suppressing STAT3 activation. This suggests that ISL has an anti-metastatic effect on NPC cells and has potential therapeutic benefit for NPC treatment.

Nasopharyngeal cancer risk assessment by country or region worldwide from 1990 to 2019

BACKGROUND

Nasopharyngeal carcinoma (NPC) is 22nd most common cancer that occurs all over the world, but the prevalence rate can exhibit significant geographical differences. The Global Burden of Disease (GBD) database provides data related to the incidence, mortality, and disease burden of NPC worldwide from 1990 to 2019. We have designed this study in order to evaluate the potential effectiveness of health care policies and strategies for NPC prevention, diagnosis and treatment in different countries or regions around the world.

METHODS

We used for the first time two distinct indicators, EAPC-ASIR and EACP-ASDR, to perform cluster analysis on 200 countries or regions around the world.

RESULTS

200 countries or regions could be divided into five diverse groups. Group 1: The incidence rate showed an increasing trend whereas the mortality rate depicted a decreasing trend. Group 2: Morbidity as well as mortality showed a slight increase; Group 3: Morbidity as well as mortality increased significantly; Group 4: Morbidity and mortality decreased significantly; Group 5: Both morbidity as well as mortality decreased slightly. Moreover, in the context of a global decline in NPC incidence, mortality and disease burden, Group 3 countries, including: "Turkmenistan", "Bosnia and Herzegovina", "Dominican Republic", "Bulgaria", "Lesotho", "Cabo Verde", "Romania", "Cuba", "Jamaica", "Azerbaijan", "Uzbekistan", "Chad", "Belize" and "Ukraine" displayed a significant increase in morbidity, mortality, and disease burden, thus indicating a dangerous trend.

CONCLUSION

It is suggested that the medical and health policies formulated by the countries in Group 3 for NPC, as well as their capacity for conducting censuses, preventing, diagnosing, and treating diseases, need to be substantially strengthened.

Efficacy and Safety of Re-Challenging PD-1 Inhibitors in Second-Line Treatment in Metastatic Nasopharyngeal Carcinoma Previously Treated with Chemotherapy and PD-1 Inhibitors

Background

We aim to evaluate the efficacy and safety of anti-PD1 rechallenge in combination with chemotherapy in patients with metastatic nasopharyngeal carcinoma (mNPC) who have progressed on prior anti-PD1 therapy.

Patients and Methods

We enrolled patients with mNPC who received chemotherapy combined with PD-1 immune-checkpoint inhibitors (ICIs) or chemotherapy alone after prior progression of anti-PD1 therapy. The primary endpoint was progress-free survival (PFS), and the secondary endpoints included overall survival (OS), disease control rate (DCR) and objective response rate (ORR).

Results

A total of 96 patients were eligible between January 2015 and December 2020. Thirty-seven (38.5%) were in the PD-1 ICIs re-challenge group, while the remaining 59 patients (61.5%) were in the chemotherapy group. The ORR and DCR of PD-1 ICIs group and chemotherapy group were 37.8% vs 23.7% and 86.5% vs.74.5%, respectively. After a median follow-up period of 21.1 months (IQR 16.1-28.7), the log-rank analysis demonstrated a significantly improved PFS in the PD-1 ICIs re-challenge group compared to the chemotherapy group (8.4 months [95% CI 4.3-14.0] vs 5.0 months [95% CI 2.8-7.2], P = 0.03). However, no significant difference in OS was observed between the two groups (28.3 vs 24.1 months, P = 0.09). The two groups had similar adverse reactions, but the incidence of grade 3 or 4 thrombocytopenia was significantly higher in the PD-1 ICIs re-challenge group (18.9% vs 3.4%, P = 0.025).

Conclusion

mNPC patients who progressed from prior anti-PD1 therapy could benefit from the anti-PD1 rechallenge in combination with chemotherapy. However, further validation is needed.

METTL14 contributes to the progression of nasopharyngeal carcinoma through regulating the stability of AOC1 mRNA

BACKGROUND

Nasopharyngeal carcinoma (NPC) is a malignant epithelial tumor of the nasopharyngeal mucosa with a high incidence rate all over the world. Methyltransferase-like 14 (METTL14) is a major RNA N6-adenosine methyltransferase implicated in tumor progression by regulating RNA function. This study is designed to explore the biological function and mechanism of METTL14 in NPC.

METHODS

METTL14 and Amine oxidase copper containing 1 (AOC1) expression were detected by real-time quantitative polymerase chain reaction (RT-qPCR). The protein levels of METTL14, AOC1, Cyclin D1, B-cell lymphoma-2 (Bcl-2), and N-cadherin were measured using western blot. Cell proliferation, cycle progression, apoptosis, migration, and invasion were assessed using 5-ethynyl-2'-deoxyuridine (EdU), Colony formation, flow cytometry, wound scratch, and transwell assays. The interaction between METTL14 and AOC1 was verified using RNA immunoprecipitation (RIP), methylated RNA immunoprecipitation (MeRIP), and dual-luciferase reporter assays. The biological role of METTL14 on NPC tumor growth was examined by the xenograft tumor model in vivo.

RESULTS

METTL14 and AOC1 were highly expressed in NPC tissues and cells. Moreover, METTL14 knockdown might block NPC cell proliferation, migration, invasion, and induce cell apoptosis in vitro. In mechanism, METTL14 might enhance the stability of AOC1 mRNA via m6A methylation. METTL14 silencing might repress NPC tumor growth in vivo.

CONCLUSION

METTL14 might boosted the development of NPC cells partly by regulating the stability of AOC1 mRNA, which provided a promising therapeutic target for NPC treatment.

Salvage endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma in a non-endemic area

PURPOSE

To analyze oncological outcomes of endoscopic surgical treatment of locally recurrent EBV-related undifferentiated non-keratinizing nasopharyngeal carcinoma (uNK-NPC) in a non-endemic area.

METHODS

Retrospective review of patients affected by recurrent uNK-NPC treated with nasopharyngeal endoscopic resection (NER) in a tertiary-care referral center from 2003 to 2022, by evaluating survival rates, prognostic factors, and follow-up strategies.

RESULTS

The oncological outcomes of 41 patients were analyzed, over a mean follow-up period of 57 months. The 5-year overall, disease-specific, and disease-free survival of the cohort were 60.7% ± 8.9%, 69% ± 9%, and 39.7% ± 9.2%, respectively. The local (rT) and regional (rN) extension of recurrent disease, stage of disease, and status of resection margins appeared to significantly influence survivals. After a mean follow-up period of 21 months, a further recurrence after NER was observed in 36.6% of cases. Skull base osteonecrosis induced by previous irradiation and post-surgical bone remodeling represent the major challenges for early detection of further local relapses during postoperative follow-up.

CONCLUSION

NER appeared as a safe and effective treatment for recurrent uNK-NPC. The adequate selection of patients eligible for NER is essential, to maximize the chances to cure and minimize the risk of local complications.

A specific super-enhancer actuated by berberine regulates EGFR-mediated RAS-RAF1-MEK1/2-ERK1/2 pathway to induce nasopharyngeal carcinoma autophagy

Nasopharyngeal carcinoma (NPC), primarily found in the southern region of China, is a malignant tumor known for its highly metastatic characteristics. The high mortality rates caused by the distant metastasis and disease recurrence remain unsolved clinical problems. In clinic, the berberine (BBR) compound has widely been in NPC therapy to decrease metastasis and disease recurrence, and BBR was documented as a main component with multiple anti-NPC effects. However, the mechanism by which BBR inhibits the growth and metastasis of nasopharyngeal carcinoma remains elusive. Herein, we show that BBR effectively inhibits the growth, metastasis, and invasion of NPC via inducing a specific super enhancer (SE). From a mechanistic perspective, the RNA sequencing (RNA-seq) results suggest that the RAS-RAF1-MEK1/2-ERK1/2 signaling pathway, activated by the epidermal growth factor receptor (EGFR), plays a significant role in BBR-induced autophagy in NPC. Blockading of autophagy markedly attenuated the effect of BBR-mediated NPC cell growth and metastasis inhibition. Notably, BBR increased the expression of EGFR by transcription, and knockout of EGFR significantly inhibited BBR-induced microtubule associated protein 1 light chain 3 (LC3)-II increase and p62 inhibition, proposing that EGFR plays a pivotal role in BBR-induced autophagy in NPC. Chromatin immunoprecipitation sequencing (ChIP-seq) results found that a specific SE existed only in NPC cells treated with BBR. This SE knockdown markedly repressed the expression of EGFR and phosphorylated EGFR (EGFR-p) and reversed the inhibition of BBR on NPC proliferation, metastasis, and invasion. Furthermore, BBR-specific SE may trigger autophagy by enhancing EGFR gene transcription, thereby upregulating the RAS-RAF1-MEK1/2-ERK1/2 signaling pathway. In addition, in vivo BBR effectively inhibited NPC cells growth and metastasis, following an increase LC3 and EGFR and a decrease p62. Collectively, this study identifies a novel BBR-special SE and established a new epigenetic paradigm, by which BBR regulates autophagy, inhibits proliferation, metastasis, and invasion. It provides a rationale for BBR application as the treatment regime in NPC therapy in future.

Long noncoding RNA TMPO-AS1 upregulates BCAT1 expression to promote cell proliferation in nasopharyngeal carcinoma via microRNA let-7c-5p

BACKGROUND

Long non-coding RNA (lncRNA) is a group of RNA transcripts that contribute to tumor development by post-transcriptionally regulating cancer-related genes. Nasopharyngeal carcinoma (NPC) is an epithelial tumor that occurs in the nasopharynx and is common in North Africa and Southeast Asia. The study investigated the functions of lncRNA TMPO-AS1 in NPC cell proliferation and apoptosis as well as its related competing endogenous RNA (ceRNA) mechanism.

METHODS

Candidate microRNA and genes that may regulated by TMPO-AS1 were predicted with the bioinformatic tool starBase. TMPO-AS1 expression in NPC tissue, cells, nuclear part, and cytoplasmic part was measured by RT-qPCR. MTT assay, EdU assay, and flow cytometry analysis were carried out to evaluate NPC cell viability, proliferation, and apoptosis, respectively. RNA immunoprecipitation assay and luciferase reporter assay were conducted to detect the binding between TMPO-AS1 and let-7c-5p or that between let-7c-5p and BCAT1.

RESULTS

TMPO-AS1 and BCAT1 showed high expression in NPC tissue and cells, while let-7c-5p was downregulated in NPC. The silencing of TMPO-AS1 suppressed NPC cell proliferation while promoting cell apoptosis. Moreover, TMPO-AS1 interacted with let-7c-5p and negatively regulated let-7c-5p expression. BCAT1 was a target of let-7c-5p and was inversely regulated by let-7c-5p in NPC cells. The repressive impact of TMPO-AS1 knockdown on NPC cell growth was countervailed by overexpressed BCAT1.

CONCLUSION

TMPO-AS1 accelerates NPC cell proliferation and represses cell apoptosis by interacting with let-7c-5p to regulate BCAT1 expression.

PD-1 inhibitors combined with chemotherapy versus chemotherapy alone: efficacy and prognostic analysis in recurrent metastatic nasopharyngeal carcinoma

OBJECTIVE

To evaluate the prognostic value of combining PD-1 inhibitors (toripalimab or karelizumab) with chemotherapy for treating recurrent or metastatic nasopharyngeal carcinoma (R/M NPC).

METHODS

This study retrospectively analyzed 142 patients with R/M NPC diagnosed from January 2018 to January 2022. Patients were divided into PD-1 inhibitor combined with chemotherapy group (53 patients) and chemotherapy alone group (89 patients) according to the treatment regimen. Objective remission rate (ORR), progression-free survival (PFS), and treatment-related toxicity were evaluated in both groups.

RESULTS

The overall response rate (P=0.006) and objective remission rate (ORR) (P=0.002) were significantly higher in the combination chemotherapy group than in the chemotherapy-alone group. The incidences of hypothyroidism (P<0.001) and reactive capillary hyperplasia (P<0.001) were significantly higher in the combination chemotherapy group than in the chemotherapy-alone group. Cox regression analysis showed that treatment regimen (P<0.001), age (P<0.001), treatment duration (P=0.002), and number of treatment lines (P=0.034) were independent prognostic factors affecting patients' PFS. The prediction model constructed based on these prognostic factors had high accuracy in predicting 1-year and 2-year PFS (AUC 0.746 and 0.760, respectively).

CONCLUSION

PD-1 inhibitors in combination with chemotherapy significantly improved the ORR and median PFS of patients with R/M NPC, while maintaining a favorable safety profile. Treatment regimen, age, number of lines and cycle of therapy were important independent prognostic factors for improving PFS in patients.

Synergistic action of Hedyotis diffusa Willd and Andrographis paniculata in Nasopharyngeal Carcinoma: Downregulating AKT1 and upregulating VEGFA to curb tumorigenesis

OBJECTIVE

Nasopharyngeal carcinoma (NPC) remains a challenging cancer to treat. This study investigates the molecular mechanisms of Hedyotis diffusa Willd (HDW) combined with Andrographis paniculata (AP) in treating NPC.

METHODS

Key compounds and target genes in HDW and AP were analyzed using network pharmacology. Protein-protein interaction (PPI) networks were constructed with STRING and visualized using Cytoscape. MCODE identified critical clusters, while DAVID facilitated GO and KEGG analyses. In vivo and in vitro experiments evaluated HDW-AP effects on NPC, including tumor volume, weight, Ki-67 expression, cell apoptosis, migration, invasion, cell cycle distribution, and DNA damage.

RESULTS

The database identified 495 NPC-related genes and 26 compounds in the HDW-AP pair, targeting 165 genes. Fifty-eight potential therapeutic genes were found, leading to 18 key targets. KEGG analysis revealed a significant impact on 78 pathways, especially cancer pathways. Both in vivo and in vitro tests showed HDW-AP inhibited NPC cell proliferation, migration, invasion, and induced apoptosis. Mechanistically, this was achieved through AKT1 downregulation and VEGFA upregulation.

CONCLUSION

The combination of HDW and AP targets 16 key genes to impede the development of NPC, primarily by modulating AKT1 and VEGFA pathways.

Predictive progression outcomes and risk stratification in patients with recurrent or metastatic nasopharyngeal carcinoma who received first-line immunochemotherapy

PURPOSE

Progression after first-line immunochemotherapy (ICT) for recurrent or metastatic nasopharyngeal carcinoma (R/M NPC) is a clinical concern due to subsequent limited treatment options. This study firstly predicted the progress outcome.

METHODS

A cohort of 186 R/M NPC cases that received first-line ICT was included for developing a Cox regression model for progression-free survival (PFS) and risk stratification, which was verified by cross-validation. Discrimination and calibration were evaluated. Progression sites in risk groups was shown with a Sankey diagram.

RESULTS

Baseline predictors including liver metastasis, trend of plasma Epstein-Barr virus DNA copies, lymphocyte-to-monocyte ratio, and level of platelet and lactate dehydrogenase were identified for model construction, which stratify the cohort into low, middle, and high-risk groups. The overall concordance index (C-index) was 0.67 (95% CI 0.62-0.73). The area under the curve (AUC) was 0.68 (95% CI 0.60-0.76), 0.74 (95% CI 0.66-0.82), 0.75 (95% CI 0.65-0.84) at predicting 12, 18, and 24 months PFS, indicating a moderate accuracy. Cross-validation showed the model performance was robust. Compared with the low-risk group (median PFS: 24.4 months, 95% CI 18.4 months to not reached), the high-risk group (median PFS: 7.1 months, 95% CI 6.4-10.1 months; hazard risk: 7.4, 95% CI 4.4-12.4, p < 0.001) progressed with more liver metastasis after ICT resistance.

CONCLUSION

It was the first study that described the risk factors and progression characteristics in R/M NPC patients who received first-line ICT, investigating the progression patterns, which was helpful to identify patients with different risks and help guide personalized interventions.