Integrated Serum and Spatial Metabolomics Reveals Compartmentalized Metabolic Reprogramming and Ferroptosis Susceptibility in Nasopharyngeal Carcinoma

Background: Nasopharyngeal carcinoma (NPC) is a malignancy highly prevalent in southern China. Metabolic reprogramming is a hallmark of cancer, yet the interplay between the systemic and local metabolic landscapes of NPC remains poorly characterized. This study aimed to identify serum metabolic biomarkers and characterize local tissue metabolic alterations through integrated metabolomics. Methods: We conducted a dual-compartment metabolomic investigation. Untargeted serum metabolomics was performed on 80 NPC patients and 35 healthy controls. Air flow-assisted desorption electrospray ionization mass spectrometry imaging (AFADESI-MSI) was applied to nasopharyngeal tissues (3 NPC vs. 3 chronically inflamed tissues). Cross-platform integration was performed to identify overlapping metabolic signatures, followed by least absolute shrinkage and selection operator (LASSO) regression for feature selection and logistic regression for biomarker panel construction. Results: Serum metabolomics revealed systemic perturbations involving amino acid and propanoate metabolism. Spatial metabolomics identified glycerophospholipid metabolism as the most significantly altered pathway in NPC tissues, with markedly reduced phosphatidylserine in tumor regions, and the ferroptosis pathway was significantly enriched. Cross-omics integration identified 8 overlapping metabolites, of which 5 were mapped to the biosynthesis of unsaturated fatty acids. Cysteine demonstrated excellent diagnostic performance (area under the receiver operating characteristic curve (AUC) = 0.903). A 5-metabolite combined model achieved an AUC of 0.904 (95% confidence interval (CI): 0.892–0.916). Conclusions: NPC exhibits compartmentalized metabolic reprogramming characterized by systemic amino acid and propanoate perturbations alongside local glycerophospholipid remodeling and ferroptosis susceptibility. The identified 5-metabolite serum panel shows considerable potential as a non-invasive diagnostic tool for NPC.