Alternative endpoints to the 5-year overall survival and locoregional control for nasopharyngeal carcinoma: A retrospective analysis of 2,450 patients

Recent advances in early detection of nasopharyngeal carcinoma

Nasopharyngeal carcinoma (NPC) arises from the mucosal epithelium of the nasopharynx and is frequently located in the pharyngeal crypts. This is a highly aggressive malignant tumor that frequently leads to distant metastases in many cases and poses a significant public health challenge, particularly in certain geographic regions globally. This review discusses the epidemiology, risk factors, diagnosis, and treatment options for NPC, emphasizing the importance of early detection and comprehensive management strategies in improving patient outcomes. Moreover, the article explores the intricate mechanisms that cause NPC. Comprehending these fundamental principles can assist in creating specific prevention and therapy approaches for NPC. Recent advances in diagnostic methods, including imaging tests and molecular biomarkers, are emphasized to improve early diagnosis and individualized treatment strategies for individuals with NPC. The review also explores the most recent advancements in treating early-stage (stage I and II) NPC patients, highlighting the changing landscape of individualized therapy approaches for this particular set of patients.

Short-term OS as a surrogate endpoint for 5-year OS in nasopharyngeal carcinoma in non-endemic area

PURPOSE

To address this evidence gap and validate short-term OS at less than 5 years as a reliable surrogate endpoint for 5-year OS.

METHODS

We analyzed data from the Surveillance, Epidemiology, and End Results (SEER) database, focusing on non-metastatic NPC patients diagnosed between 2010 and 2015. Patients were categorized into radiotherapy and chemoradiotherapy groups.

RESULTS

This retrospective study examined 2,047 non-metastatic NPC patients. Among them, 217 received radiotherapy, and 1,830 received chemoradiotherapy. Our analysis results indicated that the 4-year OS may serve as a reliable surrogate endpoint for patients with AJCC clinical stage I (80 vs. 78%, P = 0.250), regardless of the treatment received. Specifically, in the radiotherapy group, patients with stage I, T0-T1, and N0 NPC showed similar OS rates at 4 and 5 years (83 vs. 82%, P = 1.000; 78 vs. 76%, P = 0.250; 78 vs. 77%, P = 0.500, respectively). Similarly, patients with stage II-IV, T2-T4, and N1-3 NPC showed no significant difference in OS rates between 3 and 5 years (57 vs. 51%, P = 0.063; 52 vs. 46%, P = 0.250; 54 vs. 46%, P = 0.125, respectively) in the radiotherapy group. In the chemoradiotherapy group, only the 3-year OS rate did not significantly differ from that at 5 years in stage I patients (79vs. 72%, P = 0.063).

CONCLUSIONS

Our study suggests that short-term surrogate endpoints may be valuable for evaluating 5-year OS outcomes in NPC patients in non-endemic areas.

Prior cancer history predicts the worse survival of patients with nasopharyngeal carcinoma

PURPOSE

Previous cancers can be observed in patients with nasopharyngeal carcinoma (NPC). However, whether prior cancer diagnosis affects survival outcomes remains unknown. This study aimed to explore the impact of prior cancer on the survival of patients with NPC.

METHODS

We retrospectively collected data from 666 NPC patients between 2006 and 2018. The patients in this study were divided into those without prior cancer, with prior head and neck cancer, and prior non-head and neck cancer. The demographic data and survival of these groups were then analyzed. The independent prognostic factors for NPC were determined using multivariate Cox regression analysis.

RESULTS

We identified 25 NPC patients with prior cancer in our case series, most of whom had a history of colorectal cancer. Patients with a history of cancer were older than those without a history of cancer (p = 0.001). In the subgroup analysis stratified by the timing of prior cancer, NPC patients with prior non-head and neck cancer within 24, 36, 60, and 120 months showed worse survival than patients without prior cancer (all p < 0.05). When stratified by cancer stage, stage III NPC patients with prior non-head and neck cancer showed worse survival than patients without prior cancer (p < 0.001). Prior cancer and diabetes can predict worse survival in patients with stage III NPC.

CONCLUSION

This study demonstrated that prior cancer and diabetes are independent prognostic factors in patients with stage III NPC.

Expression Profiles of tRNA-Derived Small RNAs and Their Potential Roles in Primary Nasopharyngeal Carcinoma

Introduction: tRNA-derived small RNAs (tsRNAs), a class of small non-coding RNAs, are divided into two categories: tRNA-related fragments (tRFs) and tRNA halves (tiRNAs). Abnormal expression of tsRNAs has been found in diverse cancers, which indicates that further understanding of the function of tsRNAs will help identify new biomarkers and potential therapeutic targets. Until now, the underlying roles of tsRNAs in primary nasopharyngeal carcinoma (NPC) are still unknown.

Methods: tRF and tiRNA sequencing was performed on four pairs of NPC tissues and healthy controls. Thirty pairs of NPC samples were used for quantitative real-time polymerase chain reaction (qRT-PCR) verification, and the ROC analysis was used to evaluate the diagnostic efficiency initially. Target prediction and bioinformatics analysis of validated tRFs and tiRNAs were conducted to explore the mechanisms of tsRNAs in NPC’s pathogenesis.

Results: A total of 158 differentially expressed tRFs and tiRNAs were identified, of which 88 are upregulated and 70 are downregulated in NPC. Three validated tRFs in the results of qRT-PCR were consistent with the sequencing data: two upregulations (tRF-1:28-Val-CAC-2 and tRF-1:24-Ser-CGA-1-M3) and one downregulation (tRF-55:76-Arg-ACG-1-M2). The GO and KEGG pathway enrichment analysis showed that the potential target genes of validated tRFs are widely enriched in cancer pathways. The related modules may play an essential role in the pathogenesis of NPC.

Conclusions: The tsRNAs may become a novel class of biological diagnostic indicators and possible targets for NPC.

Molecular landscape and subtype-specific therapeutic response of nasopharyngeal carcinoma revealed by integrative pharmacogenomics

Nasopharyngeal carcinoma (NPC) is a malignant head and neck cancer type with high morbidity in Southeast Asia, however the pathogenic mechanism of this disease is poorly understood. Using integrative pharmacogenomics, we find that NPC subtypes maintain distinct molecular features, drug responsiveness, and graded radiation sensitivity. The epithelial carcinoma (EC) subtype is characterized by activations of microtubule polymerization and defective mitotic spindle checkpoint related genes, whereas sarcomatoid carcinoma (SC) and mixed sarcomatoid-epithelial carcinoma (MSEC) subtypes exhibit enriched epithelial-mesenchymal transition (EMT) and invasion promoting genes, which are well correlated with their morphological features. Furthermore, patient-derived organoid (PDO)-based drug test identifies potential subtype-specific treatment regimens, in that SC and MSEC subtypes are sensitive to microtubule inhibitors, whereas EC subtype is more responsive to EGFR inhibitors, which is synergistically enhanced by combining with radiotherapy. Through combinational chemoradiotherapy (CRT) screening, effective CRT regimens are also suggested for patients showing less sensitivity to radiation. Altogether, our study provides an example of applying integrative pharmacogenomics to establish a personalized precision oncology for NPC subtype-guided therapies.

Correlation Between β-Catenin Expression and Staging in Nasopharyngeal Carcinoma Patients

Nasopharyngeal carcinoma (NPC) is a malignant disease derived from nasopharyngeal epithelial cells that have a higher tendency for invasion and metastasis to the cervical lymph nodes than other head-neck malignancies. NPC patients with the same stages often show different progressions and prognoses. This suggests that clinical stages are not sufficient to predict progressivity, so biomarkers are required to provide better progression predictions. Some literature shows that the development and progression of NPC is a complex mechanism involving various components of signal paths, it plays a role in regulating the process of proliferation, angiogenesis and apoptosis. One of the most studied is β-catenin protein that is a key component of the canonical Wnt signal pathway. The β-catenin protein is reported to have roles in increasing the proliferative pathway of c-Myc and cyclin D1, increasing the expression of IL-8 proangiogenesis factor, decreasing expression of RASSF1A tumor suppressor and inhibiting apoptosis through the barriers of caspace-9 activity. To determine the association of β-catenin expression and staging in nasopharyngeal carcinoma patients. The research design used was analytic observational research with cross sectional approach. Samples were enrolled using consecutive sampling. The β-catenin expression was examined from the NPC tissue paraffin block with the immunohistochemical cracking technique, using an anti-β-catenin rabbit polyclonal antibody from Boster Biotechnology, California, USA. The β-catenin expression was assessed visually using a binocular light microscope and a scoring method according to the Allred scale index by an Anatomical Pathology consultant. Statistical analysis was performed using Spearman's test to determine the association between β-catenin expression and staging in NPC patients. The significance level was α = 0.05. The study was conducted from May to December 2015 at Otolaryngology Unit of Dr. Soetomo General Soetomo, Surabaya. There were 40 patients who fulfilled the inclusion criteria. Spearman test results obtained p value = 0.060. The correlation of β-catenin expression with staging in NPC patients was found to be non-significant (p > 0.05). There was no correlation between β-catenin expression and staging in NPC patients.

Oncologic outcomes of IMRT versus CRT for nasopharyngeal carcinoma: A meta-analysis

BACKGROUND

Nasopharyngeal carcinoma (NPC) is a prevalent malignancy in Asia particularly southern China. Comparisons of outcomes of conformal radiotherapy (CRT) and intensity-modulated radiotherapy (IMRT) have been still debated. This meta-analysis was carried out to compare oncologic outcomes of CRT and IMRT in the treatment of NPC.

METHODS

A literature search was performed through PubMed, Embase, and the Cochrane library databases from their inceptions to November 10, 2018. Two authors assessed the included studies and extracted data independently. Relative studies that compared oncologic outcomes between CRT and IMRT for NPC were included.

RESULTS

A total of 13 eligible studies were included, which contained 1 RCT, 1 prospective study, and 11 retrospective studies. Our meta-analysis showed that IMRT has increased overall survival (OR = 0.51, 95% CI = 0.41-0.65, P < .00001), locoregional control rate (OR = 0.59, 95% CI = 0.52-0.67, P < .00001), disease-free survival (OR = 0.77, 95% CI = 0.65-0.91, P = .002), and metastasis-free survival (OR = 0.71, 95% CI = 0.54-0.94, P = .01) in comparison with CRT.

CONCLUSION

The results of this meta-analysis indicate IMRT should be a better option for the treatment of NPC because patients who underwent IMRT may benefit from increased overall survival, locoregional control rate, disease-free survival, and metastasis-free survival compared with CRT.

Surrogate endpoints shortening the therapeutic evaluation duration for different subgroups of patients with nasopharyngeal carcinoma receiving intensity-modulated radiotherapy: A retrospective analysis of 830 patients stratified by the 8th edition of the UICC/AJCC staging system and plasma Epstein-Barr viral

Purpose: Investigating surrogate endpoints shortening the time of therapeutic evaluation in nasopharyngeal carcinoma (NPC) after radical treatment.

Patients and Methods: We retrospectively analyzed 830 patients receiving intensity-modulated radiotherapy (IMRT) from 2008 to 2010 and being stratified by the 8th edition of UICC/AJCC staging system and the plasma Epstein-Barr virus DNA (EBV DNA). The annual rates of overall survival (OS), progression-free survival (PFS), loco-regional recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were sequentially calculated using the life table and compared by the McNemar method.

Results: The time of shortening therapeutic evaluation by surrogate endpoints: OS, PFS, LRFS and DMFS could be shortened to 1-year (100% vs 100%, P=1) in patients with stage I; OS, PFS, LRFS and DMFS could be shortened to 3-year (96.9% vs 96.1%, P = 1; 94.6% vs 92.2%, P = 0.125; 96.9% vs 95.3%, P = 0.5) and 4-year (92.2% vs 91.2%, P = 0.125) in stage II; In the high EBV DNA group , OS and DMFS could be shortened to 1-year (100% vs 100%, P = 1;100% vs 100%, P = 0.25) in stage II; OS and PFS could be shortened to 3-year (94.3% vs 91.4%, P = 1;82.9% vs 74.3%, P = 0.25) in stage III; OS could be shortened to 4-year (75% vs 72.7%, P = 1) in stage IVA.

Conclusions: The time of therapeutic evaluation could be shortened to <5-year in stages I-II patients. The year of surrogate endpoints could be ahead in stages II-IVA with high EBV DNA.

Genome-wide analysis of long non-coding RNA in primary nasopharyngeal carcinoma by microarray

AIMS

Alterations in the expression of several long non-coding RNAs (lncRNAs) have been found in primary nasopharyngeal carcinoma (NPC). However, the effect of lncRNA expression on primary NPC as well as the molecular mechanism of lncRNA remains vague. This study was to identify differentially expressed lncRNAs involved in NPC on a genome-wide scale and predict their potential functions.

METHODS AND RESULTS

Using high-throughput microarray with 30,586 lncRNA and 26,109 mRNA probes, 856 lncRNAs and 767 mRNAs were expressed differentially between NPC and chronic nasopharyngitis tissues. Bioinformatic analysis (clustering analysis, gene ontology analysis and pathway analysis) was used for further research. Differentially expressed lncRNAs were subgrouped into three types and differentially expressed mRNAs were clustered into 28 pathways. The first coexpression network analysis revealed that 46 lncRNAs interacting with three mRNAs involved the Janus kinase-signal transducer and activator of transcription (JAK-STAT) signalling pathway. Quantitative real-time polymerase chain reaction (PCR) verified 11 up- and down-regulated lncRNAs and eight mRNAs in NPC. The second coexpression network analysis showed that 23 significantly aberrantly expressed mRNAs interacted with three validated lncRNAs.

CONCLUSIONS

This study could provide new insight into the molecular mechanisms of lncRNAs and their potential role in NPC for further study. These differentially expressed lncRNAs may act as novel biomarkers and therapeutic targets for NPC.

Association of Epstein Barr virus A73 gene polymorphism with nasopharyngeal carcinoma

OBJECTIVE

To study the association between Epstein Barr (EB) virus A73 gene polymorphism and nasopharyngeal carcinoma (NPC) in a Chinese Han population.

METHODS

A case-control study was designed, including 510 nasopharyngeal cancer patients and 520 healthy controls, A157154C genotypes of the A73 gene in EB virus were detected, genotype and allele frequency distribution between the two groups were compared.

RESULTS

The C allele frequency in the NPC group was significantly higher than that in the control group (68.4% vs. 61.2%; p<0.001). The CC genotype frequency in the NPC group was significantly higher than that in the control group, the difference was significant (47.4% vs. 41.2%; p<0.001). The CC genotype frequency in male patients was significantly higher than that in female patients in the NPC group, the difference was significant (50.3% vs. 34.7%; p<0.001).

CONCLUSION

A157154C polymorphism of the A73 gene in EB virus was associated with NPC susceptibility.