A prominently altered pathway in NPC is the MAPK signaling pathway (EGFR, NRAS, MEF2A, HRAS, KRAS, RAC1, P < 0.001, Figure 2B), which was also observed in our study, but only partially in agreement with a previous study.10 A “hot spot” mutation in HRAS (exon3: p.Q61R, ParsSNP score = 0.48) was observed in one case. Here, MEF2A is linked to nasopharyngeal carcinoma.