Caracterização sociodemográfica, clínico-patológica e de fatores que impactam na sobrevida de pacientes com carcinoma de nasofaringe diagnosticados e tratados em um centro de alta complexidade em oncologia do sus: coorte retrospectiva

Abstract

Introduction: Nasopharyngeal carcinoma (NPC) is a malignant neoplasm arising from the nasopharyngeal epithelium, frequently associated with Epstein–Barr virus (EBV) infection. Although its global incidence is low and largely concentrated in East and Southeast Asia, NPC is uncommon in non-endemic regions such as Brazil. Given the scarcity of studies in non-endemic settings, it is relevant to characterize the profile of Brazilian patients with NPC and to identify prognostic factors within the context of care provided by Brazil’s Unified Health System (SUS). Objective: To characterize the sociodemographic and clinicopathological profile of patients diagnosed with NPC and treated at a SUS High-Complexity Oncology Center (CACON), and to evaluate factors affecting overall survival and disease-free survival. Methods: This retrospective observational cohort study included 150 patients diagnosed with NPC between 2006 and 2018 at the Araújo Jorge Cancer Hospital, Goiânia, Brazil. Sociodemographic variables, clinicopathological characteristics, treatment data, adherence to the Preventive Dental Protocol (PDP), and survival outcomes were collected from medical records within the Hospital Cancer Registry (HCR). Overall survival (OS) was defined as the time from diagnosis to death, and disease-free survival (DFS) as the time from the end of treatment to recurrence/ progression. Survival curves were estimated using the Kaplan–Meier method and compared with the log-rank test. Multivariable survival analysis was performed using Cox proportional hazards regression. Associations between categorical variables were assessed using the chi-square test. Statistical significance was set at p < 0.05 with a 95% confidence interval. Results: The cohort was predominantly male (63.3%), with a median age of 51 years and a predominance of mixedrace (pardo) individuals (56.7%). The mean time to definitive diagnosis was 5.5 months. Most tumors were staged as T4 (34.7%) with nodal involvement classified as N3 (34.7%). The most frequent histological subtype was nonkeratinizing undifferentiated carcinoma (49.3%). EBV status was available for 20% of the sample and showed no significant association with histological subtype or prognosis (p > 0.05). The main therapeutic modality was concurrent chemoradiotherapy (64.7%). The most prevalent adverse effects were mucositis (48%), dysphagia (36.7%), and xerostomia (26%). Mean follow-up was 77.16 months (62.64–91.69). A total of 84 deaths were recorded, with an overall survival rate of 44.5%. Adherence to the PDP was observed in 78% of patients and was significantly associated with higher OS (p < 0.01). OS was also associated with age (p = 0.028), sex (p = 0.02), and T (p < 0.01) and N (p < 0.01) staging. DFS was statistically significant in relation to M staging (p < 0.01). Sex, T and N staging, and adherence to the PDP were independent prognostic factors impacting OS. Conclusion: In a SUS CACON setting, NPC was most often diagnosed at advanced stages, which negatively affected survival. Adherence to the PDP was associated with improved OS, suggesting that dental follow-up is essential in oncologic care.