VLDL and LDL Subfractions Enhance the Risk Stratification of Individuals Who Underwent Epstein–Barr Virus‐Based Screening for Nasopharyngeal Carcinoma: A Multicenter Cohort Study

Abstract Serological tests for Epstein–Barr virus (EBV) antibodies have been widely conducted for the screening of nasopharyngeal carcinoma (NPC) in endemic areas. Further risk stratification of NPC can be achieved through plasma lipoprotein and metabolic profiles. A total of 297 NPC patients and 149 EBV‐positive participants are enrolled from the NCT03919552 and NCT05682703 cohorts for plasma nuclear magnetic resonance (NMR) metabolomic analysis. Small, dense very low density lipoprotein particles (VLDL‐5) and large, buoyant low density lipoprotein particles (LDL‐1) are found to be closely associated with nasopharyngeal carcinogenesis. Herein, an NMR‐based risk score (NRS), which combines lipoprotein subfractions and metabolic biomarkers relevant to NPC, is developed and well validated within a multicenter cohort. Combining the median cutoff value of the NRS (N₅₀) with that of the serological test for EBV antibodies, the risk stratification model achieves a satisfactory performance in which the area under the curve (AUC) is 0.841 (95% confidence interval: 0.811‐0.871), and the positive predictive value (PPV) reaches 70.08% in the combined cohort. These findings not only suggest that VLDL‐5 and LDL‐1 particles can serve as novel risk factors for NPC but also indicate that the NRS has significant potential in personalized risk prediction for NPC.