Nasopharyngeal carcinoma

Reproduction outcomes and prognostic significance of pregnancy after nasopharyngeal carcinoma treatment

OBJECTIVE

Many female patients with nasopharyngeal carcinoma (NPC) desire to reproduce after treatment. To evaluate the outcomes of subsequent pregnancy after NPC and explore the prognostic effects of pregnancy in women.

METHODS

Female patients with locoregional NPC were included, and their pregnancy status, newborn information, and obstetric information were collected. Pregnant patients after therapy were matched to non-pregnant patients for survival analysis and overall survival (OS), disease-free survival (DFS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRFS) were assessed.

RESULTS

Of 895 patients, 79 conceived after NPC treatment. Of these, 52 women successfully delivered, and the rest had abortions. No abnormalities were recorded in any of the newborns and the caesarean section rate was 30.1%. The median birth weight of newborns was 3.11 kg. Patients who delivered successfully were younger than those who had an abortion. Among the pregnancies, four cases of spontaneous abortion and two cases of ectopic pregnancy were recorded. No significant differences in OS, DFS, LRFS, or DMFS were observed between the 79 subsequently pregnant patients and 315 matched non-pregnant patients.

CONCLUSION

Pregnancy after NPC treatment was not associated with adverse clinical outcomes. Abortion may not be a remedial choice post-treatment in patients with NPC.

Development and validation of the symptom assessment scale for patients with nasopharyngeal cancer undergoing radiotherapy

Objective

This study aims to develop the Symptom Assessment Scale for Patients with Nasopharyngeal Cancer Undergoing Radiotherapy (SAS-NPC), based on the Symptom Experience Model.

Methods

In Phase 1, a content analysis of the literature and group discussions were conducted to construct an initial pool of 61 items. Following expert review by 16 specialists and cognitive interviews with 10 patients, the pool was refined to 56 items. In Phase 2, a convenience sampling method was used to recruit 625 patients with nasopharyngeal cancer (NPC) undergoing radiotherapy, who assessed and explored the scale items. Phase 3 focused on evaluating the scale's reliability and validity.

Results

The SAS-NPC consists of 7 dimensions and 33 items. Reliability analysis revealed a Cronbach's α coefficient of 0.928 for the total scale, a split-half reliability of 0.790, and a retest reliability of 0.828. Validity analysis showed content validity indices for each item ranging from 0.833 to 1.000, with an overall content validity index of 0.970 for the scale. Exploratory factor analysis (EFA) identified 7 common factors, which accounted for 74.505% of the total variance. Confirmatory factor analysis (CFA) demonstrated good overall model fit.

Conclusions

The SAS-NPC comprehensively captures acute and long-term symptoms associated with patients with NPC undergoing radiotherapy. The scale exhibits strong reliability and validity, making it an ideal tool for assessing NPC symptom burden and facilitating clinical symptom management.

Chemoimmunotherapy as induction treatment in concurrent chemoradiotherapy for patients with nasopharyngeal carcinoma stage IVa

BACKGROUND

Chemoimmunotherapy is the first-line therapy for patients with recurrent or metastatic nasopharyngeal carcinoma (NPC) and is currently the main induction treatment option for patients with locoregionally advanced NPC. However, it remains unclear whether combining immunotherapy with standard induction chemotherapy enhances its efficacy. This study aimed to evaluate the efficacy, toxicity, and survival outcomes of induction chemoimmunotherapy in patients with locoregionally advanced NPC.

METHODS

This study analyzed 50 patients with stage IVa NPC between January 2020 and December 2023 in our hospital. Among them, 23 received induction chemoimmunotherapy, and 27 received induction chemotherapy. All patients underwent standard platinum-based concurrent intensity-modulated radiation therapy. We compared tumor response and toxicity during induction treatment and concurrent chemoradiotherapy (CCRT) between the two groups.

RESULTS

The objective and complete response rates were significantly higher in the induction chemoimmunotherapy group compared to the induction chemotherapy group (95.7% vs 77.8%, and 39.1% vs 22.2%, respectively). All patients completed radical CCRT. Median follow-up was 24 months. Patients who received induction chemoimmunotherapy had longer event-free survival (EFS) compared to those who received induction chemotherapy (p = 0.029, Hazard Ratio and 95%confidence interval [CI]: 0.24 [0.07-0.85]). The 24-month EFS was higher in the induction chemoimmunotherapy group compared with the chemotherapy group (24-month EFS rates and 95%CI: 88.9% [95%CI: 68.3%-100%] vs 62.6% [95%CI: 43.1%-82.1%]). No significant differences in adverse events were observed between the two groups during induction treatment and CCRT.

CONCLUSIONS

Adding immunotherapy to induction chemotherapy may be an effective and safe choice for treating patients with stage IVa NPC.

Baseline audiometric assessment of newly diagnosed nasopharyngeal carcinoma patients: a multicentre cross-sectional study

Hearing impairment is one of the most common chief complaints in newly diagnosed nasopharyngeal carcinoma (NPC) patients, but baseline audiometric assessments are seldom reported. This study aims to investigate the prevalence of hearing impairment in this population through comprehensive audiometric testing and analyse the associated factors. A cohort of 187 newly diagnosed NPC patients were recruited from three hospitals. Pre-treatment comprehensive audiometric assessments, including pure-tone audiometry, tympanometry, Eustachian tube function tests and distortion product otoacoustic emissions (DPOAE), were performed to evaluate hearing impairment. Patient characteristics and tumour invasion extent were also recorded. Binary logistic regression was employed to analyse factors associated with hearing impairment. Among the patients, 27.5% of ears showed conductive hearing loss (CHL), 13.6% had sensorineural hearing loss (SNHL), and 10.4% demonstrated mixed hearing loss. Additionally, 43.6% of ears exhibited abnormal tympanograms, 86.1% had Eustachian tube dysfunction, and 77.3% failed the DPOAE test. Multivariable analysis identified subjective hearing symptoms, mastoiditis, and invasion of the tensor veli palatini muscle and Eustachian tube as factors associated with CHL. T stage, mastoiditis, and invasion of the tensor veli palatini muscle and nasal cavity were linked to abnormal tympanograms. T stage, sinusitis, and invasion of the levator veli palatini muscle significantly affected Eustachian tube function, while age influenced both SNHL and DPOAE results. Hearing impairment is prevalent among newly diagnosed NPC patients, with over half exhibiting various forms. Comprehensive baseline audiometric assessment in this population is crucial for developing individualized treatment strategies and enabling early intervention to prevent further hearing deterioration.

LPAR3 and COL8A1, as matrix stiffness-related biomarkers, promote nasopharyngeal carcinoma metastasis by triggering EMT and angiogenesis

Matrix stiffness affects the progression of nasopharyngeal carcinoma, but the underlying mechanism is still unknown. Here, we demonstrated that nasopharyngeal carcinoma tissues with distant metastasis contain large collagen deposits and strong matrix stiffness. First, we performed RNA-seq analysis of nasopharyngeal carcinoma cells cultured on polyacrylamide hydrogel systems and found that LPAR3 and COL8A1 are potential matrix stiffness markers. Based on in vivo and in vitro experiments, matrix stiffness mainly affected tumor metastasis rather than proliferation. Subsequently, we found that matrix stiffness triggers the formation of epithelial-mesenchymal transition by increasing the expression of LPAR3 in nasopharyngeal carcinoma, which is related to metastasis. In addition, matrix stiffness promotes the expression of COL8A1 secreted by nasopharyngeal carcinoma and is related to tumor angiogenesis. Simultaneous inhibition of LPAR3 and COL8A1 genes significantly reduced nasopharyngeal carcinoma invasion and metastasis. Based on the investigation, we confirmed that matrix stiffness governs the progression of nasopharyngeal carcinoma and that LPAR3 and COL8A1, as matrix stiffness related biomarkers, promote nasopharyngeal carcinoma metastasis by inducing epithelial-mesenchymal transition and angiogenesis. Overall, the in-depth exploration of matrix stiffness may provide a strategy for clinical treatment intervention and provide promising targets for clinical nasopharyngeal carcinoma treatment.

Efficacy and optimal duration of maintenance immunotherapy following systemic chemoimmunotherapy and locoregional radiotherapy in de novo metastatic nasopharyngeal carcinoma: A multicenter retrospective cohort study

This study evaluates the efficacy, optimal duration, and target population for maintenance immunotherapy (MI) in patients with de novo metastatic nasopharyngeal carcinoma (dmNPC) who have achieved disease control following systemic treatment. A multicenter retrospective cohort study included 258 patients whose disease was controlled after chemoimmunotherapy and locoregional radiotherapy. The primary outcome was progression-free survival (PFS), with conditional survival and restricted mean survival time (RMST) analyses used to determine the optimal MI duration. Immune infiltration was assessed via multiplex immunohistochemistry. The results showed that the 2-year PFS was significantly higher in the MI group compared to the non-MI group (69.7% vs. 53.5%, p = .02). Multivariable analysis showed MI was an independent predictor of improved PFS (HR: 0.581, p = .006). Conditional survival and RMST analyses confirmed a significant improvement in PFS with MI continuation within 15 months. Patients with high densities of CD3+ T cells (HR: 0.546, p = .023), CD20+ B cells (HR: 370, p < .001), and a high percentage of PD-L1+ tumor cells (HR: 0.440, p = .006) had significantly better PFS compared to those with lower levels. Furthermore, MI was particularly beneficial for patients with lower densities of CD3+ T cells (p = .018), CD20+ B cells (p < .001), and lower PD-L1+ tumor cell percentages (p < .001), while this benefit was not observed in patients with higher immune infiltration levels. In conclusion, a 15-month duration of MI significantly improves PFS in patients with dmNPC after systemic treatment. Patients with lower levels of immune infiltration tend to have poorer PFS but appear to gain greater benefit from MI.

A prospective cross-sectional-comparative analysis of nutrition screening and assessment tools in chinese nasopharyngeal carcinoma inpatients undergoing radiotherapy using Global Leadership Initiative on Malnutrition criteria as the gold standard

OBJECTIVES

The aim was to assess the diagnostic accuracy of four different nutrition screening and evaluation instruments in nasopharyngeal carcinoma patients, benchmarked against Global Leadership Initiative on Malnutrition (GLIM) criteria.

METHODS AND STUDY DESIGN

An observational, single-institution study was conducted between June 2022 and May 2023. Nutrition status was assessed using Nutritional Risk Screening 2002 (NRS-2002), Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), Patient-Generated Subjective Global Assessment (PG-SGA), and GLIM criteria at two time points: postadmission and predischarge. Metrics such as sensitivity, specificity, concordance, and Kappa coefficient were computed.

RESULTS

For the trial, 140 participants were enrolled. Based on GLIM criteria, the rate of undernutrition was 22.9% before radiation and 73.6% after it ended. NRS-2002 (k = 0.721) demonstrated substantial concordance with GLIM criteria at admission, followed by MUST (k = 0.604) and MST (k = 0.378). Kappa coefficients were reduced at discharge (NRS-2002: k = 0.696; MUST: k = 0.690; MST: k = 0.496). GLIM criteria were moderately consistent with PG-SGA at admission (k = 0.453) and slightly consistent at discharge (k = 0.136).

CONCLUSIONS

NRS-2002 demonstrated greater concordance with GLIM criteria than MUST and MST. Therefore, NRS-2002 could be a more appropriate choice for initial nutrition screening in the diagnostic framework of GLIM for individuals afflicted with nasopharyngeal cancer, both before and after radiotherapy. The alignment of GLIM criteria with PG-SGA in identifying undernourished patients varied from slight to moderate.

A prognostic nomogram for patients with III-IV nasopharyngeal carcinoma based on dynamic changes in the inflammatory and nutrition index

BACKGROUND

The purpose of the study was to explore the value of dynamic changes in inflammatory and nutritional index after comprehensive treatment in patients with stage III-IVA nasopharyngeal carcinoma (NPC). A prognostic model was also established and validated for progression-free survival (PFS) of patients.

METHODS

We retrospectively selected 279 NPC patients with stage III-IVA. Their general clinical data and hematological index were collected and then calculated the changes during treatment. X-tile software was used to determine the optimal cut-off value. COX regression, Lasso method, and Boruta method were used to variable selection and model establishment. Using the bootstrap internal validation method, concordance index (C-index), calibration plot, and Kaplan-Meier curves were used to evaluate the model. To test the prognostic value of the model, we have also evaluated the performance of the nomogram against a conventional tumor metastasis staging system (TNM).

RESULTS

Multivariable COX regression analysis demonstrated that clinical staging, delta lymphocyte, delta monocyte, delta albumin, delta platelet-to-lymphocyte ratio and delta systemic immune inflammation index were related to the PFS of NPC patients. The C-index of the model was 0.712, and the calibration curve indicated that the model had good consistency. The C-index of the TNM staging system was 0.597, which was considerably lower compared to our model (P = 0.015).

CONCLUSION

We demonstrated the predictive value of dynamic changes in inflammatory and nutritional indices for the prognosis of NPC by successfully establishing and validating a prognostic model for predicting 1- and 3-year PFS after comprehensive treatment in patients with stage III-IVA NPC.

Mitochondrial function changes in T cell subsets during radiotherapy for patients with nasopharyngeal carcinoma

Mitochondrial dysfunction-mediated T cell exhaustion is associated with the efficacy of tumor therapy; however, the effect of radiotherapy (RT) on the mitochondrial function of peripheral blood immune cells remains still unclear. Therefore, the current study aimed to determine mitochondrial function indicators in immune cells, in particular mitochondrial mass (MM) and mitochondrial membrane potential (MMP), to assess the dynamic changes of immune status in patients with nasopharyngeal carcinoma (NPC) during RT. Peripheral venous blood was collected from patients with locally advanced NPC at day 1 pre-RT, at the 10th fraction of RT and within 2 days after RT. Based on a novel immunofluorescence technique, flow cytometry was used to assess the proportion of lymphocytes and their subsets in peripheral blood and the mitochondrial indexes, MM and low MMP (MMPlow). Univariate and multivariate logistic regression analyses were performed to evaluate the clinical factors associated with the efficacy of RT. A total of 27 patients were enrolled. After RT, lymphocyte count (P<0.05) and the proportion of CD4+ T cells (P<0.05) demonstrated a downward trend. In addition, the proportion of CD4+ memory-effector T (Tem; P<0.05) cells and CD8+ Tem cells (P=0.005) significantly increased during RT. No significant changes were demonstrated for MM in CD4+ effector T (Te) cells, whilst MMPlow was significantly reduced (P=0.047). However, the mitochondrial function of CD8+ T cells did not significantly change. Multivariate logistic regression analysis revealed that lymphocyte count [odds ratio (OR), 47.317; 95% confidence interval (CI), 1.240-1806.065] and MMPlow in CD4+ Te cells (OR, 0.889; 95% CI, 0.792-0.997) were independent factors that could affect clinical efficacy. Receiver operating characteristic curve analysis demonstrated that the area under the curve values for MMPlow in CD4+ T cells, lymphocyte count and their combination were 0.72 (P=0.13), 0.69 (P=0.19) and 0.89 (P=0.0073), respectively. These findings suggest that RT could inhibit immune cells in peripheral blood. However, this treatment approach could activate the memory cell subsets of immune cells and enhance the MMP of effector CD4+ T cells. Therefore, the evaluation of mitochondrial function in lymphocytes could be used as a predictor of RT efficacy in patients with locally advanced NPC.

Integration test of biaxially rotational dynamic-radiation therapy for nasopharyngeal carcinoma: Efficacy evaluation and dosimetric analysis

BACKGROUND AND PURPOSE

OXRAY is a new O-ring-shaped radiotherapy system delivering biaxially rotational dynamic-radiation therapy (BROAD-RT), a technique that enables non-coplanar volumetric-modulated arc therapy (VMAT) for large target volumes without requiring couch movement. The purpose of this study was to evaluate the benefits of BROAD-RT and to perform an integration test to confirm the plan deliverability and its accuracy from the treatment planning system to OXRAY for patients with nasopharyngeal carcinoma.

METHODS AND MATERIALS

We compared treatment plans for BROAD-RT and coplanar VMAT (COVMAT) created in RayStation for 15 patients with nasopharyngeal cancer using the Wilcoxon signed-rank test. P values less than 0.05 were considered statistically significant. Additionally, we confirmed the plan delivery accuracy of BROAD-RT from the treatment planning system to OXRAY; gamma passing rates (GPRs) and delivery time were evaluated. The criteria for pass and fail were ≥95 % at γ3%2 mm.

RESULTS

BROAD-RT significantly improved the homogeneity and conformity index of planning target volume and reduced dose volume indices compared with COVMAT in D0.03 cc for the brainstem, D0.03 cc for the left optic nerve, D0.03 cc for the brachial plexus, Dmean for each submandibular gland, Dmean for the oral cavity, and Dmean for each parotid gland. All plans for BROAD-RT passed the integration test; the mean GPR (3 %/2 mm) was above 95 % and the median delivery time was 209 s.

CONCLUSIONS

BROAD-RT delivered by OXRAY passed the integration test, and it demonstrated the potential benefit of improving the dose distribution compared with COVMAT for patients with nasopharyngeal carcinoma.

Post-irradiation Sinus Mucosa Disease in Nasopharyngeal Carcinoma Patients Treated With Proton Therapy

OBJECTIVE

Post-irradiation sinonasal mucosa disease (SMD) is observed in patients with nasopharyngeal carcinoma (NPC) treated with radiotherapy (RT), leading to a detrimental impact on quality of life. This study aimed to assess the incidence, severity, and regression of the post-irradiation SMD among patients with NPC treated with proton therapy.

METHODS

NPC patients treated with proton therapy were retrospectively enrolled. The incidence of SMD was detected using scheduled follow-up magnetic resonance images. The severity of SMD was evaluated using the Lund-Mackay (L-M) staging system. Localized inflammation of the nasopharynx was measured with the endoscopy score.

RESULTS

A total of 161 NPC patients were recruited. The incidence of SMD significantly increased from the third month to the first year after RT. The severity of SMD gradually decreased over time. Regression analyses showed that patients with pre-treatment SMD (OR = 1.75; p = 0.005) and lower serum total protein (OR = 0.16; p = 0.01) were associated with persistence of SMD at 2 years post-RT. Correlations were observed between post-RT L-M and endoscopy scores (r s = 0.239, p < 0.001). A high endoscopy score (cut-off value, 1.5 [sensitivity, 87.5%; specificity, 49.2%]) predicted the persistence of SMD.

CONCLUSIONS

Proton therapy in patients with NPC induces SMD, which peaked at 3 months post-RT, decreased gradually with time, and became insignificant at 2 years post-RT. Pre-existence of SMD and lower serum total protein levels were factors associated with the persistence of post-irradiation SMDs.

LEVEL OF EVIDENCE

4 Laryngoscope, 135:1908-1914, 2025.

DEK::AFF2-Associated Papillary Squamous Cell Carcinoma of the Sinonasal Tract: Clinicopathologic Characterization of 9 Cases

INTRODUCTION

DEK::AFF2 fusion-associated carcinoma, a recently recognized entity predominantly localized to the sinonasal tract and skull base, remains diagnostically challenging due to its poorly defined clinicopathological spectrum and epidemiological profile. Despite its deceptively bland histomorphology, this neoplasm is paradoxically linked to aggressive clinical behavior and elevated mortality rates.

PURPOSE

To delineate the clinicopathological and molecular characteristics of DEK::AFF2 fusion-associated carcinomas to elucidate their biological drivers and refine therapeutic strategies.

METHODS

A retrospective cohort study was conducted on some cases initially diagnosed as sinonasal papilloma of various types, with or without dysplasia or associated malignant transformation. DEK::AFF2 fusion was confirmed by DEK break-apart fluorescence in situ hybridization (FISH). Molecular features were assessed using immunohistochemistry (IHC) and in situ hybridization (ISH) to differential diagnosis. Clinical outcomes were analyzed for recurrence and disease-specific mortality.

RESULTS

Nine cases with DEK gene rearrangements were identified. The cohort comprised patients aged 51-76 years (median: 59 years), with a male predominance (M:F = 7:2). All cases demonstrated nuclear positivity for p40/p63 and AFF2 (30% ~90% tumor cells), while staining for p16 and Epstein-Barr encoded mRNA (EBER) was uniformly negative by IHC and ISH. Ki-67 index ranges from 5 to 40% with the median at 20%. Local recurrences occurred in 55.6% (5/9) of patients within 10-30 months following initial therapeutic intervention. The disease-specific mortality observed in 22.2% (2/9) of cases.

CONCLUSION

DEK::AFF2 fusion-associated carcinoma is characterized by a clinicopathological dichotomy: bland histological features contrast with aggressive biological behavior and poor prognosis in the nasal cavity, paranasal sinuses, and skull base.

Tissue-resident microbiota signature in nasopharyngeal carcinoma

BACKGROUND

Emerging evidence reveals that microbiota plays a crucial role in multiple cancers. Nasopharyngeal carcinoma (NPC) tissues harbour microbiota, highlighting the need to investigate the clinical implications of tissue-resident microbiota in the development of NPC. Here, we aim to clarify the specific profile of tissue-resident microbiota and its influence on NPC outcomes.

RESULTS

This retrospective study included 491 NPC patients from Sun Yat-sen University Cancer Center (Guangzhou, China) and the Affiliated Hospital of Guilin Medical College (Guilin, China). We profiled the microbial composition of 343 NPC and 36 normal nasopharyngeal tissues through sequencing of the genes encoding the 16S rRNA subunit of bacterial ribosomes. There were significant differences in microbial composition, alpha diversity (Shannon index, P = 0.007; Simpson index, P = 0.036), and beta diversity (Bray-Curtis distance: R2 = 0.016, F = 5.187, P = 0.001; unweighted UniFrac distance: R2 = 0.017, F = 5.373, P = 0.001) between NPC and normal nasopharyngeal tissues. A bacterial signature comprising four risk bacterial genera, including Bacteroides, Alloprevotella, Parvimonas, and Dialister, was constructed in the training cohort (n = 171). Patients in the high-risk group had shorter disease-free (HR 2.80, 95% CI 1.51-5.18, P < 0.001), distant metastasis-free (HR 4.00, 95% CI 1.77-9.01, P < 0.001), and overall survival (HR 3.45, 95% CI 1.77-6.72, P < 0.001) than those of patients in the low-risk group. Similar results were yielded in the internal validation (n = 172) and external validation (n = 148) cohorts. Integrated multi-omics analysis revealed that NPC tissues harbouring abundant risk bacteria were characterised by deficient immune infiltration, which was verified by multiplex immunohistochemistry.

CONCLUSIONS

This study developed and validated the applicability of a four-bacteria signature as a prognostic tool for NPC prognostication. Integrated multi-omics analysis further uncovered that the tumour immune microenvironment was perturbed by tissue-resident microbiota, which might pave the way towards the era of microbiota-targeted precision medicine for NPC. Video Abstract.

CircNTRK2 promotes the progression of nasopharyngeal carcinoma via sponging miR-384 to regulate SOX4 expression

Circular RNAs (circRNAs) have been reported to function critical roles in the pathogenesis and progression of nasopharyngeal carcinoma (NPC). The role of circNTRK2 (circbase ID: hsa_circ_0139142) remains dimness in this disease. This study aimed to investigate the effects and underlying mechanism of circNTRK2 in NPC. GSE143797 was downloaded from the Gene Expression Omnibus (GEO) database, and differently expressed circRNAs were analyzed by the GEO2R method. CircNTRK2 expression was confirmed in human NPC tumor tissues and cell lines by real-time PCR. Loss-of-function studies were used to explore the influence of circNTRK2 on the proliferation, invasion, apoptosis, and epithelial-mesenchymal transition (EMT) of NPC cells. Then, bioinformatic analysis, luciferase reporter assay, biotinylated miRNA pull-down assay, real-time PCR, and Western blotting were applied to clarify the detailed mechanism. We found that circNTRK2 was highly expressed in NPC tissues and cells. Silencing of circNTRK2 inhibited proliferation, invasion and EMT, but facilitated apoptosis of NPC cells in vitro. Also, downregulation of circNTRK2 suppressed tumor growth in a xenograft mouse model. CircNTRK2 directly targeted and negatively mediated miR-384 expression. SOX4 was a target gene of miR-384 in NPC. Both miR-384 inhibitor and SOX4 upregulation could reverse the effects of circNTRK2 knockdown on the proliferation, invasion, EMT, and apoptosis of NPC cells. Whereas miR-384 mimics and SOX4 knockdown abrogated the influences of circNTRK2 upregulation on NPC cells. In conclusion, circNTRK2 promoted NPC progression via sponging miR-384 and inhibiting miR-384 activity, leading to the upregulation of SOX4. This study indicated that circNTRK2 might be a potential target for the treatment of NPC.

Performance of MRI-based radiomics for prediction of residual disease status in patients with nasopharyngeal carcinoma after radical radiotherapy

The purpose of this study was to determine if habitat radiomic features extracted from pretherapy multi-sequence MRI predict residual status in patients with Nasopharyngeal Carcinoma (NPC) after radical radiotherapy. The retrospective study enrolled 179 primary NPC patients, divided into training and validation cohorts at a 7:3 ratio. K-means clustering was employed to segment T2WI, CE-T1WI and FSCE-T1WI images, creating habitats within the volume of interest. Identify relevant features that can recognize NPC residuals. In the training cohort, support vector machine (SVM) models were developed utilizing the radiomic features extracted from each habitat and the entire tumor, selecting the most predictive features for each sequence. SVM models were constructed by combining the optimal radiomic features from each sequences with clinical data. Model performance was compared and validated using receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA), and differences between models were assessed using the DeLong test. The optimal clustering results revealed 4 habitats in FSCE-T1WI, while 2 habitats in both CE-T1WI and T2WI sequences. In the training cohort, we compared the predictive accuracy of SVM models based on different habitats and total tumor characteristics from three sequences, and found that the features from T2 Hab2, CE-T1 Hab1, and FSCE-T1 Hab4 images showed higher performance. Incorporation of habitat-based radiomic features and clinical variables significantly enhanced the predictive performance. The integrated model exhibits the optimal predictive performance, with the area under the curve (AUC) values of 0.921 (SEN = 0.821, SPE = 0.830) in the training cohort and 0.811 (SEN = 0.778, SPE = 0.722) in the validation cohort. Compared to conventional radiomics, habitat imaging features that distinguish intratumoral heterogeneity have higher predictive value, making them potential non-invasive biomarkers for assessing NPC residual after radiotherapy. Integration of multi-sequence MRI habitat radiomic with clinical parameters further improved predictive accuracy.

Comparison of four MRI diffusion models to differentiate benign from metastatic retropharyngeal lymph nodes

BACKGROUND

Conventional magnetic resonance diffusion-weighted imaging (DWI) and morphological features have limitations in distinguishing benign from metastatic retropharyngeal lymph nodes (RLNs). We aimed to compare the value of continuous-time random walk (CTRW), fractional-order calculus (FROC), stretched-exponential model (SEM), and conventional DWI, in combination with morphological features, for differentiating between the two groups.

METHODS

Fifty-nine patients with 68 RLNs (23 benign and 45 metastatic) were enrolled. All patients underwent DWI with 12 b-values. Diffusion data were reconstructed using conventional DWI, SEM, FROC, and CTRW models, yielding nine parameters: apparent diffusion coefficient (ADC), distributed diffusion coefficient (DDC)SEM, αSEM, DFROC, βFROC, μFROC, DCTRW, αCTRW, and βCTRW. Diffusion parameters and morphological features were compared using Mann-Whitney U, independent sample t, or χ2 tests. Logistic regression analysis was performed to identify the best diffusion indicator for classification and to develop a multiparameter model combining morphological features. Area under the receiver operating curve (AUC) and DeLong tests were used.

RESULTS

Significant differences in diffusion parameters were found between benign and metastatic RLNs, except for αCTRW (p ≤ 0.022). Benign RLNs exhibited higher ADC, DDCSEM, DFROC, and DCTRW, while metastatic RLNs had higher αSEM, βFROC, μFROC, and βCTRW. Multivariate logistic regression analysis identified βCTRW as the optimal single diffusion indicator (AUC = 0.913). The combined model of βCTRW with morphological features further improved diagnostic performance and yielded an AUC of 0.948.

CONCLUSION

βCTRW is an effective noninvasive biomarker for distinguishing between benign and metastatic RLNs. Thus, combining βCTRW with morphological features enhances diagnostic efficiency.

RELEVANCE STATEMENT

This study demonstrates that βCTRW, derived from the continuous-time random walk diffusion model, when integrated with morphological features, offers a reliable, noninvasive diagnostic approach for differentiating between benign and metastatic retropharyngeal lymph nodes.

KEY POINTS

Non-Gaussian diffusion metrics outperformed conventional DWI. βCTRW was the best indicator for distinguishing benign from metastatic lymph nodes. Combining βCTRW with minimal axial diameter further improved diagnostic efficiency.

An integrative analysis combining bioinformatics, network pharmacology and experimental methods identified key genes of EGCG targets in Nasopharyngeal Carcinoma

BACKGROUND

Epigallocatechin gallate (EGCG), a frequently studied catechin in green tea, has been shown to be involved in the antiproliferation and apoptosis of human Nasopharyngeal carcinoma (NPC) cells. However, the pharmacological targets and mechanism by which EGCG can combat NPC patients remain to be studied in detail.

METHODS

Network pharmacology and bioinformatics were employed to investigate the molecular mechanisms underlying EGCG's therapeutic effects on NPC, with an emphasis on developing a prognostic risk model and identifying potential therapeutic targets.

RESULTS

A novel prognostic risk model was developed using univariate Cox regression, LASSO regression and multivariable Cox regression analyses, incorporating six genes to stratify patients into low- and highrisk groups. Kaplan-Meier analysis demonstrated significantly shorter progression-free survival in the high-risk group. The model's accuracy was further validated using time-dependent Receiver Operating Characteristic (ROC) curves. ESTIMATE analysis revealed significantly higher immune, stromal and overall ESTIMATE scores in the low-risk group compared to the high-risk group. Immune profiling indicated significant differences in five immune cell subtypes (memory B cells, regulatory T cells (Tregs), gamma delta T cells, activated NK cells and activated dendritic cells) between the two risk groups. Additionally, the low-risk group showed greater sensitivity to conventional chemotherapeutic agents. Immunohistochemistry and molecular docking analyses identified CYCS and MYL12B as promising targets for EGCG treatment.

CONCLUSION

This study utilised network pharmacology and bioinformatics to identify shared genes between EGCG and NPC, aiming to elucidate the molecular mechanisms through which EGCG inhibits NPC and to develop a prognostic model for assessing patient outcomes. The findings provide potential insights for the development of anti-NPC therapies and their clinical applications.

Viral oncogenesis in cancer: from mechanisms to therapeutics

The year 2024 marks the 60th anniversary of the discovery of the Epstein-Barr virus (EBV), the first virus confirmed to cause human cancer. Viral infections significantly contribute to the global cancer burden, with seven known Group 1 oncogenic viruses, including hepatitis B virus (HBV), human papillomavirus (HPV), EBV, Kaposi sarcoma-associated herpesvirus (KSHV), hepatitis C virus (HCV), human T-cell leukemia virus type 1 (HTLV-1), and human immunodeficiency virus (HIV). These oncogenic viruses induce cellular transformation and cancer development by altering various biological processes within host cells, particularly under immunosuppression or co-carcinogenic exposures. These viruses are primarily associated with hepatocellular carcinoma, gastric cancer, cervical cancer, nasopharyngeal carcinoma, Kaposi sarcoma, lymphoma, and adult T-cell leukemia/lymphoma. Understanding the mechanisms of viral oncogenesis is crucial for identifying and characterizing the early biological processes of virus-related cancers, providing new targets and strategies for treatment or prevention. This review first outlines the global epidemiology of virus-related tumors, milestone events in research, and the process by which oncogenic viruses infect target cells. It then focuses on the molecular mechanisms by which these viruses induce tumors directly or indirectly, including the regulation of oncogenes or tumor suppressor genes, induction of genomic instability, disruption of regular life cycle of cells, immune suppression, chronic inflammation, and inducing angiogenesis. Finally, current therapeutic strategies for virus-related tumors and recent advances in preclinical and clinical research are discussed.

Biomarkers of response to camrelizumab combined with apatinib: an analysis from a phase II trial in recurrent/metastatic nasopharyngeal carcinoma

BACKGROUND

This study aims to develop a peripheral blood-based model that can predict the response to the combination therapy of camrelizumab and apatinib as a second-line or later-line treatment regimen in patients with recurrent/metastatic nasopharyngeal carcinoma (R/M-NPC).

METHODS

We collected peripheral blood routine data from 72 patients with R/M-NPC from two clinical trial studies (NCT04547088, NCT04548271). Utilising the least absolute shrinkage and selection operator Cox regression model, we built a peripheral blood signature and developed a prognostic nomogram through multivariable analysis. Spectral flow cytometry analysed peripheral blood mononuclear cell immunophenotyping.

RESULTS

Six indicators (WBC, MCV, HCT, MCHC, P-LCR, MLR) were included to construct the peripheral blood signature. By combining this signature with Epstein-Barr virus DNA, distant lymph node metastasis and previous PD-1 inhibitor treatment, we constructed a peripheral blood-based nomogram that showed favourable performance. High-risk individuals had lower overall survival than low-risk individuals (P < 0.05). Immunophenotyping revealed that the high-risk individuals had increased monocytic myeloid-derived suppressor cells, Tregs and decreased CD8 effector memory cells (P < 0.05).

CONCLUSIONS

We established a model that could predict the prognosis of combined therapy. The model could predict outcomes and reflect the systemic immune and inflammatory status, which is beneficial for risk stratification and therapeutic modification.

TNF-α inhibits Epstein Barr virus reactivation through the GPX4 mediated glutathione pathway

Epstein-Barr virus (EBV) is a carcinogenic γ-herpesvirus that remains latent in more than 95% of adults. The virus can undergo lytic activation when immune function is suppressed or when stimulated by drugs or pathogens. EBV reactivation poses a significant threat to human health and is closely associated with various cancers, such as Burkitt's lymphoma and nasopharyngeal carcinoma. Inhibiting EBV reactivation is a current clinical challenge. Tumour necrosis factor-α (TNF-α), an important cytokine, has different effects on various viruses. It also exerts varying effects on the same virus depending on the type of infected cell. This study aimed to investigate the impact of TNF-α on EBV reactivation and its underlying mechanisms. Our experimental research revealed that TNF-α significantly inhibits EBV reactivation and that this inhibitory effect is mediated primarily through its receptor TNFR1. Furthermore, TNF-α affects the expression of the GPX4 protein and regulates the potential ferroptosis state of cells. Using transmission electron microscopy and other methods, we observed typical characteristics of ferroptosis, such as changes in mitochondrial morphology and Fe2 + accumulation. Additionally, we established stable GPX4-knockdown cell lines, which demonstrated the crucial role of GPX4 in the process of TNF-α-mediated inhibition of EBV reactivation. Overall, TNF-α acts on the TNFR1 receptor, thereby affecting the GPX4 protein and the ferroptosis pathway to achieve its inhibitory effect on EBV reactivation. These findings provide new insights into the mechanisms of EBV reactivation and may offer new perspectives for the early treatment of EBV-related diseases.

Neural Network-based Automated Classification of 18F-FDG PET/CT Lesions and Prognosis Prediction in Nasopharyngeal Carcinoma Without Distant Metastasis

PURPOSE

To evaluate the diagnostic performance of the PET Assisted Reporting System (PARS) in nasopharyngeal carcinoma (NPC) patients without distant metastasis, and to investigate the prognostic significance of the metabolic parameters.

PATIENTS AND METHODS

Eighty-three NPC patients who underwent pretreatment 18F-FDG PET/CT were retrospectively collected. First, the sensitivity, specificity, and accuracy of PARS for diagnosing malignant lesions were calculated, using histopathology as the gold standard. Next, metabolic parameters of the primary tumor were derived using both PARS and manual segmentation. The differences and consistency between the 2 methods were analyzed. Finally, the prognostic value of PET metabolic parameters was evaluated. Prognostic analysis of progression-free survival (PFS) and overall survival (OS) was conducted.

RESULTS

PARS demonstrated high patient-based accuracy (97.2%), sensitivity (88.9%), and specificity (97.4%), and 96.7%, 84.0%, and 96.9% based on lesions. Manual segmentation yielded higher metabolic tumor volume (MTV) and total lesion glycolysis (TLG) than PARS. Metabolic parameters from both methods were highly correlated and consistent. ROC analysis showed metabolic parameters exhibited differences in prognostic prediction, but generally performed well in predicting 3-year PFS and OS overall. MTV and age were independent prognostic factors; Cox proportional-hazards models incorporating them showed significant predictive improvements when combined. Kaplan-Meier analysis confirmed better prognosis in the low-risk group based on combined indicators (χ² = 42.25, P < 0.001; χ² = 20.44, P < 0.001).

CONCLUSIONS

Preliminary validation of PARS in NPC patients without distant metastasis shows high diagnostic sensitivity and accuracy for lesion identification and classification, and metabolic parameters correlate well with manual. MTV reflects prognosis, and its combination with age enhances prognostic prediction and risk stratification.

Tumor-infiltrating CD4+ CD25+ FOXP3+ Treg is associated with plasma EBV DNA and disease progression in nasopharyngeal carcinoma

BACKGROUND

Regulatory T cells (Tregs) play a significant role in immune evasion within the tumor microenvironment (TME). Nasopharyngeal carcinoma (NPC) is strongly associated with Epstein-Barr virus (EBV) infection. Previous studies have shown that EBV can suppress immune activity. The relationship between plasma EBV DNA levels and Treg infiltration in NPC remains to be elucidated. Some studies have shown that FOXP3, a Treg marker, is a favorable prognostic factor in NPC. However, relying solely on FOXP3 for Treg identification may be unreliable due to its expression in other cell types. Therefore, this study investigated the impact of tumor-infiltrating Tregs identified by CD4, CD25, and FOXP3 triple markers in NPC and the relationship between these Tregs and EBV infection.

METHODS

In this study, 103 NPC patients were included. All tumor slides were stained using multi-immunofluorescence with CD4, CD25, and FOXP3. HALO software was used to analyze whole-slide images. The correlation between two factors was assessed using Spearman analysis. The prognostic value of factors was evaluated using Kaplan-Meier curves and Cox regression.

RESULTS

A significant positive correlation was observed between Treg infiltration in tumor tissues and plasma EBV DNA levels (r = 0.3428, p = 0.02). Higher Treg infiltration was significantly associated with poorer progression-free survival (PFS) (p = 0.03) and was an independent risk factor for NPC progression (p = 0.045). CD25 expression was positively correlated with plasma EBV DNA levels (r = 0.3229, p = 0.03). Furthermore, increased Treg infiltration was negatively correlated with peripheral CD8+ T cells (r=-0.3556, p = 0.006). The proportion of peripheral CD8+ T cells in patients with advanced-stage NPC was significantly lower compared to those with early stage (p = 0.02).

CONCLUSION

This study identified tumor-infiltrating CD4+CD25+FOXP3+ Tregs as an independent negative prognostic factor for NPC progression and found higher Treg infiltration positively associated with plasma EBV DNA levels.

SYT7 accelerates nasopharyngeal carcinoma progression via ALDH1A3-mediated STAT3 signaling activation

Nasopharyngeal carcinoma (NPC) is a special histological and ethical type of head and neck cancer with unsatisfactory clinical outcome. Thus, exploring effective molecular targets is critical for NPC treatment. We observed increased expression levels of synaptotagmin-7 (SYT7) in NPC tissues, which correlated with unfavorable prognoses. Furthermore, knockdown of SYT7 in NPC cells suppressed proliferation and migration rates, and enhanced apoptosis. In contrast, overexpression of SYT7 accelerated NPC tumor growth. Using whole-genome gene arrays and immunoprecipitation-mass spectrometry assays, aldehyde dehydrogenase 1 family member A3 (ALDH1A3), a regulator of glycolytic metabolism, was identified as a critical downstream target of SYT7. Mechanistically, SYT7 binds and promotes ALDH1A3 deubiquitination, resulting in decreased ALDH1A3 degradation. Notably, we also observed an increased expression of ALDH1A3 in NPC. More importantly, the knockdown of ALDH1A3 resulted in suppressed proliferation, migration, glycolysis, and promoted apoptosis, all of which could be restored by the overexpression of SYT7 in NPC cells. Taken together, we found that SYT7 increases ALDH1A3-mediated STAT3 activation and glycolysis, contributing to NPC progression, which provides a possible molecular mechanism for the development of targeted therapeutics interventions.

Comparison of 68Ga-DOTATATE and 18F-FDG PET/CT for tumor staging and primary tumor volume delineation in patients with nasopharyngeal carcinoma

This study evaluated the clinical utility of 68Ga-DOTATATE PET/CT compared to 18F-FDG PET/CT for tumor staging and the delineation of primary tumor volume in patients with non-keratinizing nasopharyngeal carcinoma (NPC). Forty-two individuals with pathologically confirmed non-keratinizing NPC were recruited. This study compared the detection rates of primary and metastatic tumors and the accuracy of tumor staging using two PET/CT modalities. Tumor volumes defined on PET scans using the absolute SUV of 2.5 (TH2.5), 40% of the maximum SUV (TH40%), and the relative background-dependent threshold (THbgd) were analyzed in comparison to MRI results. Comparing 68Ga-DOTATATE and 18F-FDG PET/CT, identifying primary tumors (initial detection, 100% vs. 97.3%; recurrent detection, 80.0% vs. 100%) and lymph node metastases (99.0% vs. 100%) were comparable. However, 68Ga-DOTATATE PET/CT detected more skull base bone (100% vs. 96.3%) and intracranial invasion (100% vs. 54.5%) than 18F-FDG, and consequently correctly upwardly adjusted the T-staging in 7 patients. 68Ga-DOTATATE PET/CT detected an equal number of lung metastases (24/24) but more bone metastases (97.8% vs. 84.4%) compared to 18F-FDG PET/CT, yet was less effective for liver metastases (30.4% vs. 100%). Compared with 18F-FDG PET/CT, 68Ga-DOTATATE PET/CT correctly upstaged 5 subjects and downstaged 1 subject in overall staging. Tumor volumes assessed by 68Ga-DOTATATE PET compared to 18F-FDG PET using the three threshold methods demonstrated less variability and higher agreement with MRI. Among the methods, THbgd for lesion segmentation in 68Ga-DOTATATE PET demonstrated the highest confidence level and concordance with MRI (ICC 0.95). In conclusion, 68Ga-DOTATATE PET/CT is a beneficial complement to 18F-FDG PET/CT for NPC staging, with higher accuracy for primary tumor volume delineation.

A biomimetic therapeutic nanovaccine based on dendrimer-drug conjugates coated with metal-phenolic networks for combination therapy of nasopharyngeal carcinoma: an in vitro investigation

Developing a minimally invasive and potent therapy for nasopharyngeal carcinoma is still challenging. In this study, we report a photothermal nanovaccine based on phenylboronic acid (PBA)-modified poly(amidoamine) dendrimers of generation 5 (G5) attached with indocyanine green (ICG) as a photothermal agent, toyocamycin (Toy) as an endoplasmic reticulum stress (ERS) drug, and Mn2+-coordinated metal-phenolic networks. The developed nanocomplexes are camouflaged with homologous apoptotic cancer cell membranes, leveraging membrane proteins as an antigenic reservoir and incorporating the immune adjuvant cytosine-guanine (CpG) oligonucleotide to obtain the final nanovaccine formulation. The prepared nanovaccine with a size of 72.4 nm displays satisfactory colloidal stability and photothermal conversion efficiency (36.7%), and is capable of targeting cancer cells and inducing apoptosis under laser irradiation through combined ICG-mediated photothermal therapy, Toy-enabled chemotherapy and Mn2+-mediated chemodynamic therapy. Meanwhile, the combined therapeutic effects can elicit immune responses to mature dendritic cells through the immunogenic cell death of cancer cells and the inserted CpG adjuvant/apoptotic cancer cell membranes, and polarize tumor-associated macrophage cells to the antitumor M1 phenotype. The antitumor efficacy of the nanomedicine platform was proven by the test of the penetration and therapeutic inhibition of 3-dimensional tumor spheroids in vitro. The developed functional nanomedicine integrated with different therapeutic modes may be developed as a biomimetic therapeutic nanovaccine for nasopharyngeal carcinoma treatment.

Determining the optimal duration of oral adjuvant chemotherapy in locoregionally advanced nasopharyngeal carcinoma

BACKGROUND

Concurrent chemoradiotherapy (CCRT) followed by adjuvant chemotherapy (AC) is the standard treatment for locoregionally advanced nasopharyngeal carcinoma (LA-NPC). However, the optimal duration of oral AC remains poorly defined.

METHODS

This study examined newly diagnosed patients between April 2017 and December 2020. The primary endpoint was overall survival (OS). Restricted cubic splines (RCS) and Kaplan-Meier method were used to evaluate the relationship between AC maintenance and survival. Inverse probability of treatment weighting (IPTW) was used to control for confounding factors.

RESULTS

The RCS demonstrated an L-shaped association between oral AC maintenance and OS. The risk of mortality was relatively flat after 12 months. Patients with oral AC duration >186 days (defined by RCS) had a significantly better OS (HR 0.23 [95% CI 0.10-0.55], log-rank p < 0.001), with a higher 3-year OS rate (98.7% [95% CI 96.8-100.0] vs 88.3% [95% CI 82.5-94.5]). For patients with pretreatment Epstein-Barr virus (EBV) DNA level >4000 copies/mL, mortality risk decreased to 1 at 194 days of AC duration.

CONCLUSIONS

The optimal duration of oral AC after CCRT was >186 days (6 months) for LA-NPC. And the maintenance beyond 12 months may not bring additional benefits.

Nimotuzumab combined with docetaxel and cisplatin as first-line treatment for patients with recurrent or metastatic nasopharyngeal carcinoma: a multicenter, phase 2 trial

BACKGROUND

To evaluate the efficacy and safety of nimotuzumab combined with docetaxel and cisplatin (TPN) as the first-line therapy in patients with recurrent or metastatic nasopharyngeal carcinoma (RM-NPC).

METHODS

In this multicenter, open-label, phase 2 trial (ClinicalTrials.gov identifier: NCT03708822), patients with RM-NPC received intravenous nimotuzumab (200 mg on days 1, 8, and 15), docetaxel (75 mg/m2 on day 1), and cisplatin (75 mg/m2 on day 1) every 3 weeks for 6 cycles. The primary endpoint was the objective response rate (ORR), and the secondary endpoints included the disease control rate (DCR), duration of response (DOR), time to response (TTR), progression-free survival (PFS), overall survival (OS), and safety.

RESULTS

Between October 15, 2018, and July 20, 2022, 52 patients were enrolled. The ORR and DCR in the intention-to-treat population were 65.4% and 90.4%, respectively. With a median follow-up of 38.1 months, the median PFS and OS were 7.4 and 40.4 months, respectively. The majority of adverse events were grades 1-2. Grade 3/4 adverse events were neutropenia (42.3%), leukopenia (32.7%), febrile neutropenia (11.5%), nausea (7.7%), fatigue (5.8%), infection (5.8%), thrombocytopenia (1.9%), and anorexia (1.9%). There was no treatment-related death. Low baseline plasma Epstein-Barr virus (EBV) DNA level and the clearance of plasma EBV DNA after 2 cycles of treatment were associated with longer PFS. Additionally, patients who received ≥ 2400 mg of nimotuzumab and ≥ 4 cycles of docetaxel plus cisplatin had superior ORR and survival.

CONCLUSIONS

First-line therapy with the TPN regimen showed promising efficacy with a well-tolerated safety profile in RM-NPC patients.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT03708822.

Polycyclic Aromatic Hydrocarbons Regulate the Occurrence and Development of Nasopharyngeal Carcinoma by Regulating Aryl Hydrocarbon Receptor

Nasopharyngeal carcinoma (NPC) has hidden onset, low rate of early diagnosis, and most of them have metastases at the time of diagnosis. The specific pathogenesis of NPC is still unclear. Polycyclic aromatic hydrocarbons (PAHs) are a large group of contaminants produced by the incomplete combustion of organic matter and widespread in the air. Many of these compounds are mutagenic and carcinogenic. PAHs plays an important role in mutagenic and carcinogenic, while its role in NPC still needs further elucidation. In this study, CNE-2 cells were stimulated by PAHs, then the expression of aryl hydrocarbon receptor (AhR) and CYP1A2 were respectively examined using Real-Time fluorescence quantitative PCR (qRT-PCR) and Western Blot. CNE-2 cells proliferation, migration, invasion and apoptosis were examined by CCK-8, Wound-Healing Assay, Transwell, Flow Cytometry, respectively. We found that AhR expression was increased while the level of apoptosis was inhibited by PAHs. While the ability of cell invasion was weakened, proliferation and migration were not significantly different. After treated by PAHs and ITE, the effect of PAHs on promoting AhR expression was significantly inhibited and apoptosis was up-regulated. The present study found that, PAHs inhibit apoptosis of NPC cells and promote the expression of AhR. Besides, PAHs participates in NPC occurrence and development by regulating AhR expression. Collectively, these findings may provide a possible strategy for the clinical treatment of NPC.

Effect of enhanced recovery after radiotherapy (ERAR) on the quality of life in patients with nasopharyngeal carcinoma after radiotherapy: A randomized controlled trial

Nasopharyngeal carcinoma is prevalent in Southern China and Southeast Asia, which is effectively managed through chemoradiotherapy for locoregionally advanced cases (LA-NPC). Despite current guidelines endorsing various rehabilitation regimens for surgery, evidence supporting the benefits of rehabilitation during systemic radiotherapy is scarce. Thus we introduce the Enhanced Recovery After Radiotherapy (ERAR) concept. We enrolled patients with stage III to IVA LA-NPC in this study. The ERAR group received comprehensive interventions encompassing nursing, oral care, psychology support, rehabilitation, nutrition, and skin health throughout their radiotherapy. The standard care group received conventional radiotherapy rehabilitation. Outcomes were evaluated at baseline, the 17th and 33rd radiotherapy sessions. Generalized estimating equations were used to evaluate group by time effects on the outcomes, controlling for key covariates. A total of 104 LA-NPC patients with a mean age of 49.2 ± 10.9 years were enrolled in the study group from August 2021 to September 2023. The ERAR group showed significant improvements in quality of life (P = 0.014), Hospital Anxiety and Depression Scale (HADS) anxiety (P < 0.001), HADS depression (P < 0.001), distress thermometer (P = 0.049), NRS2002 (P = 0.040), weight loss (P < 0.001), and Oral Health Impact Profile-14 (OHIP-14) (P = 0.040) scores outperforming the standard care group at all measured time points. The ERAR protocol significantly mitigates acute radiation-induced toxicities in LA-NPC patients. This study is anticipated to serve as a reference for clinicians and encourage the adoption of a standardized protocol aimed at facilitating rapid recovery post-radiotherapy.

Correlation of 18 F-FDG PET/CT metabolic parameters with Ki-67 expression and tumor staging in nasopharyngeal carcinoma

PURPOSE

The study aimed to investigate the imaging parameters of 18F-fluorodeoxyglucose ( 18 F-FDG) PET/computed tomography (PET/CT) in nasopharyngeal carcinoma (NPC), specifically examining the relationship between mean standardized uptake value (SUVmean), maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) with Ki-67 expression, T-stage, and tumor node metastasis (TNM) stage.

METHODS

A retrospective analysis was conducted on 143 consecutive NPC patients from January 2015 to December 2023 who underwent 18 F-FDG PET/CT for initial disease assessment. SUVmax, SUVmean, MTV, and TLG were quantified from PET/CT images. Immunohistochemical staining was used to assess Ki-67 protein expression. Correlations between 18 F-FDG PET/CT metabolic parameters, Ki-67 expression, T-stage, and TNM-stage were evaluated using statistical methods, with significance set at P  < 0.05.

RESULTS

All primary NPC lesions demonstrated elevated 18 F-FDG uptake. Significant positive correlations were observed between SUVmax ( r  = 0.234, P  = 0.005), SUVmean ( r  = 0.223, P  = 0.007), MTV ( r  = 0.218, P  = 0.009), and TLG ( r  = 0.232, P  = 0.005) with Ki-67 labeling index. The univariate analysis indicated that all the parameters (SUVmax, SUVmean, MTV, and TLG) in the group with Ki-67 ≥ 50% were significantly higher than those in the group with Ki-67 < 50% ( P  = 0.001). Additionally, binary logistic regression analysis revealed that SUVmax was an independent risk factor for the group with Ki-67 ≥ 50% ( P  = 0.003). The univariate analysis revealed that all parameters (SUVmax, SUVmean, MTV, and TLG) in the T3-4 group and clinical stage IV group were significantly higher than those in the T1-2 group and stages I-III group ( P both <0.05), respectively. Furthermore, binary logistic regression analysis demonstrated that MTV was an independent risk factor for both comparisons ( P both <0.05).

CONCLUSION

The metabolic parameters derived from 18 F-FDG PET/CT in NPC indirectly reflect tumor biological behavior, suggesting their potential utility in guiding individualized comprehensive treatment strategies.

Long-term Outcomes Following Individualized Primary Tumor Clinical Target Volume Delineation Based on Stepwise Spread Patterns of Nasopharyngeal Carcinoma Treated With Intensity-Modulated Radiotherapy

PURPOSE

Our institution has developed an individualized elective primary tumor clinical target volume (CTVp) delineation protocol for nasopharyngeal carcinoma (NPC) based on stepwise tumor spread patterns in intensity modulated radiation therapy for over 10 years. Herein, we report the long-term efficacy and toxicities in patients with NPC treated under this protocol.

METHODS AND MATERIALS

A total of 7262 patients with histologically proven nonmetastatic NPC treated with intensity modulated radiation therapy following this individualized delineation protocol were retrospectively evaluated. Survival rates were estimated using the Kaplan-Meier method. Dose-volume histogram parameters for patients with local relapse were compared with those of propensity score-matched without local relapse. Dosimetric comparisons of our delineation protocol with the 2018 International Guideline (2018-IG) were conducted on representative early- and advanced-stage NPC cases.

RESULTS

The 5-year local relapse-free survival, regional relapse-free survival, distant metastasis-free survival, progression-free survival, and overall survival were 93.6%, 94.4%, 86.8%, 77.8%, and 86.0%, respectively. 92.3% of local relapses and 86.0% of regional relapses occurred within the 95% isodose lines and were considered in-field failures. No significant differences in dose-volume histogram parameters were observed between the local relapse group and the propensity score-matched nonrelapse group. Compared with the 2018-IG, our contouring protocol resulted in a 58.4% and 48.3% reduction in PTV70, and an 80.8% and 62.8% reduction in PTV60 for early and advanced-stage diseases, respectively. Late grade 3 toxicities included ototoxicity (1.8%), xerostomia (0.2%), dysphagia (0.2%), temporal lobe injury (0.2%), and trismus (0.1%).

CONCLUSIONS

Individualized elective CTVp delineation based on the stepwise spread patterns of nasopharyngeal carcinoma achieved excellent long-term outcomes and reduced the irradiated volumes at equivalent dose levels compared with the 2018-IG.

ANKRD22 Induced by Transcription Factor MAZ Promotes Proliferation and Invasion of Nasopharyngeal Carcinoma

Nasopharyngeal carcinoma (NPC) is very common in Southeast China, with the characteristics of high aggression and metastasis. Ankyrin repeat domain-containing protein 22 (ANKRD22) contributes to tumor growth in different tumors, but its role in NPC is still unknown. This study set out to address the action of ANKRD22 in the progression of NPC. The ANKRD22 expression was examined by reverse transcription quantitative polymerase chain reaction and western blot. The function of ANKRD22 in the progression of NPC was addressed through Cell Counting Kit-8, flow cytometry, transwell, luciferase, chromatin immunoprecipitation, and western blot assays. Besides, the in vivo role of ANKRD22 in NPC was assessed using immunohistochemistry and terminal deoxynucleotidyl transferase deoxyuridine triphosphate (dUTP) nick end labeling (TUNEL) assays after nude mice were administrated with HK-1 cells transfected with sh-ANKRD22. The ANKRD22 expression was upregulated in NPC, which predicted a poor prognosis in NPC patients. Knockdown of ANKRD22 suppressed growth and invasion, but enhanced apoptosis in NPC cells. Mechanically, MYC-associated zinc finger protein (MAZ) was a transcription factor of ANKRD22 that positively modulated the ANKRD22 expression in NPC cells. MAZ/ANKRD22 axis accelerated proliferation and invasion, but repressed apoptosis in NPC cells. In vivo, silencing of ANKRD22 diminished the tumor size and weight, the expression of Ki-67 and ANKRD22, but increased apoptosis of NPC. ANKRD22 was transcriptionally modulated by MAZ, which promoted proliferation and invasion, but suppressed apoptosis of NPC.

Molecular Profiling of Nasopharyngeal Carcinoma Using the AACR Project GENIE Repository

BACKGROUND

Nasopharyngeal carcinoma (NPC) is a rare head and neck cancer arising from the mucosal lining of the nasopharynx, for which systemic therapeutic options remain scarce, reflecting the limited characterization of its genomic profile. This study utilized a large patient-level genomic repository to characterize genetic alterations, identify potential therapeutic targets, and improve disease modeling in NPC.

METHODS

A retrospective analysis of NPC samples was conducted using the AACR Project GENIE database. Targeted sequencing data were analyzed for recurrent somatic mutations, tumor mutational burden, and chromosomal copy number variations, with significance set at p < 0.05.

RESULTS

Frequent mutations were identified in KMT2D (20%), TP53 (16%), CYLD (9.6%), NFKBIA (6.4%), and PIK3CA (5.6%), implicating the p53, NF-κB, and PI3K pathways in NPC development. Notably, significantly distinct mutational profiles were observed based on both sex and race, with female patients exhibiting higher frequencies of PIK3C2G, ETV6, and CDKN1B mutations and non-Asian patients showing enrichment in KDM5A, CCND2, and TP53 mutations.

CONCLUSIONS

This study presents a detailed genomic profile of NPC, identifying key mutations within established cancer-associated pathways. The identification of frequently mutated pathways (p53, NF-κB, and PI3K) suggests potential targets for novel therapies. Furthermore, distinct mutational landscapes in female and Asian NPC patients offer possibilities for precision therapeutic interventions.

Induction versus Concurrent Chemotherapy for Advanced Nasopharyngeal Carcinoma

BACKGROUND

Cisplatin-based concurrent chemoradiotherapy (CCRT) is the mainstay treatment for locoregionally advanced nasopharyngeal carcinoma (LA-NPC), which usually leads to intolerable toxicities. We investigated whether or not induction chemotherapy (IC) plus intensity-modulated radiation therapy (IMRT) could replace CCRT.

METHODS

This is an open-label, phase 3, noninferiority trial. Patients with stage T1-4N2-3 or T3-4N0-1 LA-NPC were randomly assigned (1:1) to receive gemcitabine (1000 mg/m2) and cisplatin (80 mg/m2) for two cycles followed by IMRT, or IMRT plus concomitant weekly cisplatin (40 mg/m2) for up to seven cycles. Two-year failure-free survival (FFS) was the primary end point, and noninferiority was confirmed by an upper limit of the 95% confidence interval (CI) for a hazard ratio of less than 2.12 (absolute margin of -10 percentage points). Secondary end points include overall survival, locoregional recurrence-free survival, distant metastasis-free survival, toxicity profile, and quality of life (QoL).

RESULTS

We enrolled 124 patients in the IC group and 125 patients in the CCRT group. The median follow-up was 60 months. Two-year FFS was 90.2% for IC versus 86.3% for CCRT, with a hazard ratio of 0.636 (95% CI, 0.267 to 1.514) and an absolute difference of 3.9 percentage points (95% CI, -5.2 to 13.0). Compared with the CCRT group, fewer grade ≥3 adverse events occurred in the IC group (47.5% vs. 61.5%; P=0.029), including leukopenia, anemia, mucositis, nausea, and dysphagia. IC was associated with better QoL, including global health status, social and cognitive functioning, fatigue, nausea and vomiting, pain, appetite loss, and constipation.

CONCLUSIONS

For 2-year FFS for LA-NPC, gemcitabine and cisplatin IC plus IMRT alone was noninferior to CCRT. (Funded by Key-Area Research and Development of Guangdong Province and others.).

Endoscope-assisted trans-oral approach (EATA) to remove a rare pleomorphic adenoma of the nasopharynx

BACKGROUND

Pleomorphic adenomas are benign tumors that typically arise from the salivary glands, most commonly the parotid gland. However, they can also occur in minor salivary glands and ectopic salivary tissue, and in very rare cases, these tumors arise in the nasopharynx.

CASE REPORT

We present a rare case of a pleomorphic adenoma originating from the nasopharynx in a 49-year-old female patient. The patient was affected by snoring, bilateral nasal obstruction, and bilateral otitis media with effusion. Radiological investigations identified a well-defined mass in the nasopharynx. The tumor was successfully removed via a transoral approach, and histopathological examination confirmed the diagnosis of pleomorphic adenoma.

CONCLUSION

This case highlights the importance of considering pleomorphic adenoma in the differential diagnosis of nasopharyngeal masses, even though rarely occurs in this location. Complete surgical excision with preservation of the tumor capsule is crucial to prevent recurrence.

Recent advances in the role of circRNA in cisplatin resistance in tumors

Cancer remains a major threat to human health, with chemotherapy serving as one of the main treatment strategies to alleviate patient suffering. However, prolonged chemotherapy often leads to the development of drug resistance, complicating treatment outcomes. Cisplatin, a commonly utilized chemotherapeutic agent, demonstrates efficacy against a range of cancers but frequently encounters resistance, posing a significant challenge in tumor management and prognosis. Drug resistance not only facilitates tumor progression but also reduces survival rates, highlighting the urgent need for innovative strategies to overcome this issue. In recent years, non-coding RNAs, particularly circular RNAs (circRNAs), have gained attention in cancer therapy due to their stability and specificity. Moreover, an increasing number of studies have reported that circRNAs are involved in cisplatin resistance across various types of cancer. This paper primarily reviews the mechanisms and roles of circRNA in mediating cisplatin resistance over the past 3 years. These findings highlight circRNAs as promising therapeutic targets for overcoming cancer drug resistance.

Head and Neck Squamous Cell Carcinoma of Unknown Primary-Who Can Be Offered Surgery as the Sole Treatment Modality? A Systematic Review

OBJECTIVE

Evaluate the role of surgery as the sole treatment modality for patients with cervical head and neck squamous cell carcinoma of unknown primary (HNSCCUP).

DESIGN

Systematic review of observational cohort studies with qualitative synthesis.

SETTING

PubMed, Ovid EMBASE, and Cochrane Controlled register of Trials (CENTRAL) were screened from January 2000 up to October 2021.

PARTICIPANTS

Patients with HNSCCUP after completing diagnostic workup subsequently treated with single-modality surgery.

MAIN OUTCOME MEASURES

The primary outcome was 3-year overall survival (OS). Secondary outcomes included disease-free survival (DFS), primary emergence, regional recurrence, and distant metastasis.

RESULTS

Fourteen eligible studies were identified, including 1780 patients, of whom 294 received surgery as their sole treatment (seven studies) with 3-year OS ranging from 43.9% to 100%. 3-year DFS was reported in four studies (n = 62) ranging from 42.8% to 67.0%. 5-year OS and DFS were available in three studies (n = 31), ranging from 36.6% to 75.0%, and 43.6% to 67.0%, respectively. The rate of primary emergence ranged from 11.1% to 33.3% (seven studies, n = 157), regional relapse from 0.0% to 50.0% (five studies, n = 60) and distant metastasis from 0.0% to 3.3% (three studies, n = 45). Patients undergoing surgery as a sole treatment had predominantly p16/HPV positive N1 (TNM7) disease without ECS.

CONCLUSION

Outcomes for HNSCCUP patients undergoing surgery alone range widely in the literature but may be reasonable in a subset of patients with early-stage p16/HPV positive disease. Data is lacking for p16/HPV negative disease where the potential primary site is more varied and primary emergence appears more common.

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.

Mutant p53 confers chemoresistance by activating KMT5B-mediated DNA repair pathway in nasopharyngeal carcinoma

Nasopharyngeal carcinoma (NPC), a malignancy arising from the nasopharyngeal epithelium, is common in the east and southeast area of Asia. Treatments for locally advanced and recurrent NPC include chemotherapy (usually combined with 5-Fluorouracil, 5-FU) and radiotherapy, but response is limited due to chemo-resistance. p53 mutation is a critical factor for 5-FU resistance in some cancers, but its role in NPC chemo-resistance remains unclear. Here, we demonstrate that p53(R280T), a common p53 somatic mutation found in multiple NPC tumor samples, induces gain-of-function upregulation of DNA repair genes which leads to 5-FU resistance in NPC. p53(R280T) specifically upregulates the expression of DNA repair-associated gene KMT5B by binding to its promoter, which leads to 5-FU resistance. Depletion of KMT5B in NPCs restores 5-FU induced DNA damages and improve the efficacy of 5-FU. By screening compounds affecting KMT5B expression, we identify curcumin as an effective down-regulator of KMT5B in NPC cells. We therefore evaluate the therapeutic potential of a 5-FU/curcumin combination to treat NPC and discover that curcumin enhances the efficacy of 5-FU to suppress NPC tumor growth. In summary, our findings indicate that mutant p53 and its regulated DNA repair genes serve as potential therapeutic targets to reverse 5-FU resistance for NPC patients.

Identification of key hub genes and potential therapeutic drugs for nasopharyngeal carcinoma: Insights into molecular mechanisms and treatment strategies

OBJECTIVE

Nasopharyngeal Carcinoma (NPC) is a highly malignant cancer with a high incidence in East and Southeast Asia, including southern China. Despite advances in treatment, the prognosis for advanced NPC remains poor due to high recurrence and metastasis rates. The molecular mechanisms driving NPC progression are not fully understood, and identifying key genes and potential therapeutic agents is critical. This study aims to uncover critical genes and screen therapeutic drugs, providing insights into NPC pathogenesis and novel treatment strategies.

METHODS

Three GEO datasets (GSE12452, GSE53819, and GSE61218) were analyzed to identify overlapping Differentially Expressed Genes (DEGs) in NPC. Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and Gene Set Enrichment Analysis (GSEA) were used to explore the biological roles of DEGs. Protein-Protein Interaction (PPI) and mRNA-miRNA-lncRNA interaction networks were constructed to identify key hub genes. Potential therapeutic drugs were predicted via a Drug-Gene Interaction network. The overexpression of hub genes was validated in NPC cells using CCK-8 assays, and the anti-proliferative effects of three drugs ‒ valproic acid, cyclosporine, and calcitriol ‒ were tested.

RESULTS

Eight hub genes (ASPM, BIRC5, BUB1B, CDK1, KIF23, PBK, TOP2A, and TTK) were identified, with ASPM reported for the first time in the context of NPC. Overexpression of these genes significantly promoted NPC cell proliferation. Among the tested drugs, calcitriol exhibited the most potent anti-proliferative effect, with IC50 values of 0.90 μM, 0.47 μM, and 0.31 μM at 24-, 48-, and 72-hs, respectively.

CONCLUSION

This study identified eight key genes as potential biomarkers for NPC and validated calcitriol as a promising therapeutic agent, providing a foundation for further research into NPC treatment.

LEVEL OF EVIDENCE

Level 2 (Individual cross-sectional studies or systematic review of surveys that allow matching to local circumstances).

Sesamin Exerts Anti-Tumor Activity in Nasopharyngeal Carcinoma Through Inducing Autophagy and Reactive Oxygen Species Production

BACKGROUND

Sesamin can suppress many cancers, but its effect on nasopharyngeal carcinoma (NPC) is unclear. Herein, we set out to pinpoint the possible changes in NPC due to Sesamin.

METHODS

The biological function of NPC cells exposed to Sesamin/N-acetyl-L-cysteine (NAC)/3-Methyladenine (3-MA) was detected, followed by evaluation of reactive oxygen species (ROS) production (dichlorodihydrofluorescein diacetate staining) and mitochondrial membrane potential (MMP) (flow cytometry). Proteins pertinent to apoptosis (cleaved caspase-3, cleaved poly (ADP-ribose) polymerase 1 (PARP1)), cell cycle (Cyclin B1), and autophagy (microtubule-associated protein light chain 3 (LC3)-I, LC3-II, Beclin-1, P62) were quantified by Western blot. After the xenografted tumor model in mice was established, the tumor volume and weight were recorded, and Ki-67 and cleaved caspase-3 levels were determined by immunohistochemical analysis.

RESULTS

Sesamin inhibited viability, proliferation, cell cycle progression and migration, induced apoptosis, increased ROS production, and decreased MMP in NPC cells. Sesamin elevated cleaved caspase-3/caspase-3, cleaved PARP1/PARP1, and Beclin-1 expressions as well as LC3-II/LC3-I ratio, while diminishing Cyclin B1 and P62 levels. NAC and 3-MA abrogated Sesamin-induced changes as above in NPC cells. Sesamin inhibited the increase of the xenografted tumor volume and weight, down-regulated Ki-67, and up-regulated cleaved caspase-3 in xenografted tumors.

CONCLUSION

Sesamin exerts anti-tumor activity in NPC, as demonstrated by attenuated tumor proliferation and xenografted tumor volume and weight, as well as induced apoptosis in tumor tissues, consequent upon the promotion of autophagy and reactive oxygen species production.

Deubiquitinating enzyme UCHL1 stabilizes CAV1 to inhibit ferroptosis and enhance docetaxel resistance in nasopharyngeal carcinoma

The overexpression of CAV1 in many cancers is linked to chemotherapy resistance, but the exact mechanisms by which CAV1 contributes to resistance in nasopharyngeal carcinoma (NPC) are not fully known. Our research aims to elucidate the potential pathways by which CAV1 contributes to chemotherapy resistance in NPC, providing a basis for developing strategies to overcome resistance. A docetaxel-resistant NPC cell line was established, and CAV1 expression was analyzed in the cell line and the resistant variant using western blot. The sensitivity of the resistant cell line to docetaxel was assessed via cell counting kit-8, colony formation assays, and flow cytometry. Flow cytometry was used to measure lipid reactive oxygen species levels, while kits were employed to determine Fe2+ and malondialdehyde concentrations. The Ubibrowser database helped identify ubiquitination enzymes that interact with CAV1. The binding relationship between UCHL1 and CAV1 was studied using co-immunoprecipitation and immunofluorescence, which also evaluated the deubiquitination activity of UCHL1 on CAV1. CAV1 is overexpressed in NPC tissues and cells, correlating with adverse patient prognoses. In docetaxel-resistant cells, CAV1 expression is elevated compared to standard NPC cells. Silencing CAV1 increased the sensitivity of these resistant cells to docetaxel. Additionally, treatment with the ferroptosis inducer erastin could counteract the effects of CAV1 overexpression on drug resistance. UCHL1 interacted with CAV1 and inhibited its ubiquitin-mediated degradation pathway. By deubiquitinating CAV1, UCHL1 stabilizes and increases its expression, which inhibits ferroptosis and enhances the resistance of NPC cells to docetaxel.

Lactoferrin in cancer: Focus on mechanisms and translational medicine

Lactoferrin is an iron-binding glycoprotein that provides natural protective effects to the human body. Its biological properties, including antibacterial, antiviral, anti-inflammatory, immune-regulatory, and iron metabolism-regulating functions, have been extensively studied. With further research, lactoferrin's impact on tumorigenesis and tumor microenvironment has become increasingly evident, as it inhibits tumor proliferation, invasion, and metastasis through multiple pathways. This article summarizes the molecular mechanisms underlying lactoferrin's anticancer effects, explores its association with the malignant progression of various cancers, and highlights its clinical translational potential as a potential cancer biomarker and drug delivery carrier to enhance anticancer therapy efficiency. Due to the high safety profile of lactoferrin, its widespread application in the field of cancer treatment is highly anticipated.

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.

Accurate and Efficient Detection of Nasopharyngeal Carcinoma Using Multi-Dimensional Features of Plasma Cell-Free DNA

BACKGROUND

The incidence of Nasopharyngeal carcinoma (NPC) is rising in recent years, especially in some non-developed parts of the world. Hence, cost-efficient means for sensitive detection of NPC are vital.

METHODS

We recruited 646 participants, including healthy individuals, patients with benign nasopharyngeal diseases, and NPC patients for plasma cell-free DNA(cfDNA), which underwent low-depth whole-genome sequencing (WGS) to extract multi-dimensional molecular features, including fragmentation pattern, end motif, copy number variation(CNV), and transcription factors(TF). Based on these features, we employed a machine learning algorithm to build prediction models for NPC detection.

RESULTS

We achieved a sensitivity of 95.8% and a specificity of 99.4% to discriminate NPC patients from healthy individuals.

CONCLUSIONS

This study can be a proof-of-concept for these multi-dimensional molecular features to be implemented as a noninvasive approach for the detection and even early detection of NPC.

CAPRIN1/TYMS/MTHFD2 axis promotes EMT process in nasopharyngeal carcinoma development

BACKGROUND

Nasopharyngeal carcinoma (NPC) is a type of malignant tumor occurring in the nasopharynx. It frequently leads to treatment failure after metastasis, often resulting from epithelial-mesenchymal transition (EMT). Thymidylate synthetase (TYMS) is a key enzyme involved in DNA synthesis and replication. Currently, the role of TYMS and its mechanism of upstream and downstream in EMT of NPC is unclear.

METHODS

NPC cell lines HK-1 and C666-1 were used in this study. Lentivirus carrying TYMS knockdown and overexpressed plasmids were used to regulate TYMS expression. Cell migration and invasion were examined using the wound-healing and Transwell assays, respectively. C666-1 cells were injected into the axilla and tail vein of mice to form subcutaneous tumors and construct lung metastasis model, respectively. RNA immunoprecipitation assay was used to examine the interaction between protein and mRNA. RNA-seq was performed to explore the downstream regulatory mechanism of TYMS.

RESULTS

TYMS was highly expressed in NPC tissues. TYMS silencing and upregulation inhibited and promoted EMT processes in NPC cells, respectively, as demonstrated by the expression of EMT-related proteins, including E-cadherin, Slug, MMP2, and MMP9. Cytoplasmic activation/proliferation-associated protein-1 (CAPRIN1), a protein bound with TYMS mRNA, promoted the EMT process in NPC cells. Meanwhile, TYMS knockdown reversed the effect of CAPRIN1 overexpression. Methylenetetrahydrofolate dehydrogenase 2 (MTHFD2) was down-regulated following TYMS silencing. MTHFD2 knockdown abolished the effect of TYMS overexpression.

CONCLUSION

CAPRIN1/TYMS/MTHFD2 axis drives the EMT process and thus promotes NPC development, which is a promising target in therapy and adjuvant therapy of NPC.

The influence of evidence-based nutritional support plans on the nutritional status and adverse effects of radiotherapy in individuals with nasopharyngeal carcinoma

Objective

Radiotherapy serves as the primary treatment for patients with nasopharyngeal carcinoma (NPC). However, it frequently results in a progressive decline in nutritional status, which is linked to unfavorable clinical outcomes. This study aims to evaluate the effects of an evidence-based nutritional support program on nutritional status, radiotherapy-related side effects, and quality of life (QoL) in NPC patients undergoing radiotherapy.

Methods

A historical control trial was conducted. Patients with NPC admitted between May 2023 and August 2023 were allocated to the control group and received routine care, whereas those admitted between September 2023 and December 2023 were assigned to the intervention group and provided with a multidisciplinary, professional, individualized, and comprehensive evidence-based nutritional support program. Nutritional status was assessed through anthropometric measurements (e.g., body mass index, BMI), laboratory indicators (hemoglobin and albumin levels), the Nutritional Risk Screening 2002 (NRS2002), and the Patient-Generated Subjective Global Assessment (PG-SGA). Additionally, radiotherapy-related side effects, radiotherapy interruption rates, and QoL were monitored.

Results

Both groups comprised 40 patients each. By the conclusion of radiotherapy, a decline in nutritional status was observed in both groups; however, BMI was higher in the intervention group (23.14 ± 2.62) compared to the control group (21.38 ± 2.73). The NRS2002 score (2.73 ± 1.45) and PG-SGA score (6.13 ± 3.22) in the intervention group were significantly lower than in the control group (3.33 ± 1.16 and 7.73 ± 2.72, respectively; p < 0.05). The incidence of severe malnutrition was significantly lower in the intervention group (52.5%) compared to the control group (75%) (p < 0.05). Albumin and hemoglobin levels were significantly higher in the intervention group (albumin: 120.75 ± 16.52 vs. 113.50 ± 12.08, p = 0.028; hemoglobin: 41.24 ± 4.54 vs. 37.62 ± 5.04, p = 0.001). The severity of radiotherapy-related side effects, including radiation-induced oral mucositis, dermatitis, and myelosuppression, was significantly lower in the intervention group (p < 0.05). All patients completed radiotherapy, and no significant difference was observed in radiotherapy interruption rates between groups (control group: 6 interruptions; intervention group: 1 interruption; p > 0.05). Post-radiotherapy QoL scores demonstrated that the intervention group achieved superior outcomes in physical, role, emotional, cognitive, and social functioning (p < 0.05).

Conclusion

Implementing evidence-based nutritional support programs has the potential to prevent the decline in nutritional status among NPC patients receiving radiotherapy, reduce the occurrence of treatment-related side effects, and enhance overall quality of life.