Nasopharyngeal carcinoma (NPC) is a rare malignancy with unique genetic, viral and environmental characteristic that distinguishes it from other head and neck carcinomas. The clinical management of NPC remains challenging largely due to the lack of early detection strategies for this tumor. In our study, we have sought to identify novel genes involved in the pathogenesis of NPC that might provide insight into this tumor's biology and could potentially be used as biomarkers. To identify these genes, we studied the epigenetics of NPC by characterizing a panel of methylation markers. Eighteen genes were evaluated by quantitative methylation-specific polymerase chain reaction (PCR) in cell lines as well as in tissue samples including 50 NPC tumors and 28 benign nasopharyngeal biopsies. Significance was evaluated using Fisher's exact test and quantitative values were optimized using cut off values derived from receiver-operator characteristic curves. The methylation status of AIM1, APC, CALCA, deleted in colorectal carcinomas (DCC), DLEC, deleted in liver cancer 1 (DLC1), estrogen receptor alpha (ESR), FHIT, KIF1A and PGP9.5 was significantly associated with NPC compared to controls. The sensitivity of the individual genes ranged from 26 to 66% and the specificity was above 92% for all genes except FHIT. The combination of PGP9.5, KIF1A and DLEC had a sensitivity of 84% and a specificity of 92%. Ectopic expression of DCC and DLC1 lead to decrease in colony formation and invasion properties. Our results indicate that methylation of novel biomarkers in NPC could be used to enhance early detection approaches. Additionally, our functional studies reveal previously unknown tumor suppressor roles in NPC.Nasopharyngeal carcinoma (NPC) is a relatively rare head and neck malignancy in the United States. The global age adjusted incidence is one per 100,000 per year representing 0.7% of all cancers.1 In contrast, certain southern regions of China have an incidence as high as 50 cases per 100,000 per year.2 In fact in Hong Kong, NPC is the leading cancer in men age 20-44 years representing 25% of all cancers.3 NPC is particularly interesting because of its unique genetic, viral and environmental factors. Epstein-Barr virus (EBV) is a critical factor for malignant transformation in NPC. 4 However, only a small fraction of widespread EBV-infected patients will develop a NPC and not all NPC are EBV positive.5 EBV is present in more than 95% of the endemic Type I non-keratinizing lesions, while 30-50% of the Type II keratinizing lesions in the non endemic regions are EBV negative.6 Aside from EBV, environmental exposure to food preservatives in food, salted fish and occupational exposures have been related to increased NPC incidence.
3The initial presentation of NPC varies widely but rarely is the disease localized to the nasopharynx. Commonly, patients present with advanced disease that has metastasized to the