# The correlation between epithelial–mesenchymal transition classification and MMP2 expression of circulating tumor cells and prognosis of advanced or metastatic nasopharyngeal carcinoma

## TL;DR

This study explores how the EMT classification and MMP2 expression in circulating tumor cells relate to the prognosis of advanced nasopharyngeal carcinoma patients undergoing radiotherapy.

## Contribution

The study identifies hybrid CTCs and MMP2 expression as potential prognostic markers for relapse in advanced NPC after radiotherapy.

## Key findings

- CTC counts increase during radiotherapy but decrease afterward.
- Higher pre-radiotherapy TNM stages correlate with lower CTC counts.
- Hybrid CTCs and MMP2 expression are linked to a higher risk of relapse.

## Abstract

Epithelial–mesenchymal transition (EMT) and circulating tumor cells (CTCs) are key prognostic factors in nasopharyngeal carcinoma (NPC). However, the role of EMT status in CTCs for predicting outcomes in advanced NPC treated with radiotherapy after induction chemotherapy remains unclear.

A total of 143 CTC tests from 95 advanced/metastatic NPC patients were analyzed before, during, and after radiotherapy, with a 60-month follow-up. CTC count, matrix metalloproteinase 2 (MMP2)) protein expression, and EMT subtypes were examined.

During radiotherapy, CTC counts increase but decrease afterward. Patients with higher pre-radiotherapy tumor-node-metastasis (TNM) stages have lower total and M-subtype CTC counts. Higher T and TNM stages during radiotherapy correlate with increased EMT-state CTCs, especially hybrid CTCs. EA/IgG-positive patients have a higher number of hybrid CTCs and E-type (epithelial + hybrid) CTCs, while EBV-EA-negative patients have more mesenchymal CTCs. A higher post-radiotherapy CTC count predicts relapse, and the positive rate of MMP2 expression on hybrid and epithelial CTCs is higher than that on mesenchymal CTCs.

EMT status, particularly in hybrid CTCs, is a potential prognostic marker for relapse in advanced NPC after radiotherapy.