Emerging biomarkers for nasopharyngeal carcinoma early diagnosis and prognosis

Abstract Nasopharyngeal carcinoma (NPC) is a common malignant head and neck tumor originating in the nasopharynx. Its incidence exhibits distinct geographical heterogeneity. Although global incidence rates have declined in recent years, the disease remains highly prevalent in East and Southeast Asia. Early-stage NPC has a cure rate approaching 90 %; however, its insidious onset and non-specific symptoms often delay diagnosis until advanced stages. This results in limited treatment efficacy, poor prognosis, and a 5-year overall survival rate of less than 15 %. Current screening relies mainly on Epstein-Barr virus (EBV)-related markers, which show high performance in endemic regions but limited sensitivity and positive predictive value in non-endemic settings. Therefore, there is an urgent need for reliable biomarkers suitable for population screening, risk stratification, and prognostic evaluation. This review offers a systematic synthesis of recent advances in NPC diagnostic biomarkers, dividing them into six categories based on molecular characteristics: genetic, epigenetic, proteomic, microbiomic, metabolomic, and extracellular vesicles (EVs) biomarkers. These multi-omics biomarkers offer a comprehensive landscape for earlier detection and individualized management of NPC and lay the groundwork for future integrative, region-tailored screening strategies. We anticipate that this review will foster continued progress toward the development and clinical translation of more effective biomarkers for the diagnosis, prognosis, and therapeutic stratification of NPC.