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Id: biblio-887329
Autor: Anteliz García, Eliana T; Carballo, Carolina M; Estévez, Samanta; Diana, Sofía; de Mena, Arturo; Manonelles, Gabriela; Cazes, Claudia I; López, Eduardo L.
Título: Actinomicosis orofaríngea como diagnóstico diferencial de carcinoma de cavum: Reporte de un caso / Cervicofacial actinomycosis as differential diagnosis of cavum carcinoma: case report
Fonte: Arch. argent. pediatr;115(3):166-169, jun. 2017. ilus.
Idioma: es.
Resumo: La actinomicosis es una enfermedad infrecuente en pediatría que implica, habitualmente, un desafío diagnóstico. Es producida por bacterias del género Actinomyces. La forma cervicofacial suele originarse tras la disrupción de la mucosa oral secundaria a alteraciones odontógenas. Se presenta el caso de una adolescente que, tras la colocación de un piercing en la lengua, comenzó con odinofagia y cambios del tono de voz. Luego de ocho meses de persistencia de los síntomas y habiendo realizado múltiples tratamientos antibióticos con leve mejoría, se efectuó una biopsia y se diagnosticó carcinoma de cavum, por lo que se derivó a este Hospital para su tratamiento. Al analizar nuevamente la biopsia, se descartó la patología oncológica y se diagnosticó actinomicosis orofaríngea. Cumplió 6 meses totales de tratamiento antibiótico, con buena evolución. Si bien la colocación de piercings orales no ha sido descrita hasta el momento como factor de riesgo, la disrupción mucosa generada podría favorecer el inicio del cuadro.

Paediatric actinomycosis is an infrequent infectious disease caused by Actinomyces spp. Cervicofacial infections are usually related to disruption in oral mucosal membranes. We discuss the case of a 15-year-old girl who refers an 8-month history of odynophagia and changes in her tone of voice after getting a tongue piercing. She received multiple antibiotic treatments with slight improvement. Nasopharyngeal carcinoma was diagnosed by endoscopic biopsy. The patient was referred to our Hospital for treatment but, when the biopsy was analyzed again, oncological pathology was excluded and oropharyngeal actinomycosis was diagnosed. She received a total of 6 months of antibiotic treatment with favorable evolution.
Descritores: Actinomicose Cervicofacial/diagnóstico
Carcinoma/diagnóstico
Neoplasias Nasofaríngeas/diagnóstico
-Diagnóstico Diferencial
AMERICAN HEART ASSOCIATIONACENAPHTHENES
Limites: Seres Humanos
Feminino
Adolescente
Tipo de Publ: Relatos de Casos
Responsável: AR94.1 - Centro de Información Pediatrica


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Texto completo SciELO Brasil
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Id: biblio-890736
Autor: Plzák, Jan; Kratochvil, Vít; Kešner, Adam; Šurda, Pavol; Vlasák, Aleš; Zvěřina, Eduard.
Título: Endoscopic endonasal approach for mass resection of the pterygopalatine fossa
Fonte: Clinics;72(9):554-561, Sept. 2017. tab, graf.
Idioma: en.
Projeto: Ministry of Health of the Czech Republic.
Resumo: OBJECTIVES: Access to the pterygopalatine fossa is very difficult due to its complex anatomy. Therefore, an open approach is traditionally used, but morbidity is unavoidable. To overcome this problem, an endoscopic endonasal approach was developed as a minimally invasive procedure. The surgical aim of the present study was to evaluate the utility of the endoscopic endonasal approach for the management of both benign and malignant tumors of the pterygopalatine fossa. METHOD: We report our experience with the endoscopic endonasal approach for the management of both benign and malignant tumors and summarize recent recommendations. A total of 13 patients underwent surgery via the endoscopic endonasal approach for pterygopalatine fossa masses from 2014 to 2016. This case group consisted of 12 benign tumors (10 juvenile nasopharyngeal angiofibromas and two schwannomas) and one malignant tumor. RESULTS: No recurrent tumor developed during the follow-up period. One residual tumor (juvenile nasopharyngeal angiofibroma) that remained in the cavernous sinus was stable. There were no significant complications. Typical sequelae included hypesthesia of the maxillary nerve, trismus, and dry eye syndrome. CONCLUSION: The low frequency of complications together with the high efficacy of resection support the use of the endoscopic endonasal approach as a feasible, safe, and beneficial technique for the management of masses in the pterygopalatine fossa.
Descritores: Neoplasias Nasofaríngeas/cirurgia
Angiofibroma/cirurgia
Fossa Pterigopalatina/cirurgia
Cirurgia Endoscópica Transanal/métodos
Neurilemoma/cirurgia
-Imagem por Ressonância Magnética/métodos
Carcinoma/cirurgia
Carcinoma/patologia
Carcinoma/diagnóstico por imagem
Tomografia Computadorizada por Raios X/métodos
Neoplasias Nasofaríngeas/patologia
Neoplasias Nasofaríngeas/diagnóstico por imagem
Neoplasias Nasais/cirurgia
Neoplasias Nasais/patologia
Neoplasias Nasais/diagnóstico por imagem
Reprodutibilidade dos Testes
Estudos Retrospectivos
Seguimentos
Resultado do Tratamento
Angiofibroma/patologia
Angiofibroma/diagnóstico por imagem
Embolização Terapêutica/métodos
Fossa Pterigopalatina/patologia
Fossa Pterigopalatina/diagnóstico por imagem
Gradação de Tumores
Neurilemoma/patologia
Neurilemoma/diagnóstico por imagem
Limites: Seres Humanos
Masculino
Feminino
Adolescente
Adulto
Meia-Idade
Adulto Jovem
Responsável: BR1.1 - BIREME


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Id: lil-180283
Autor: Ikeda, Mauro K; Fogaroli, Ricardo; Weissberger, Yoram.
Título: Tumores malignos de nasofaringe / Nasopharyngeal malignant tumors
Fonte: In: Fundaçäo Antonio Prudente. Hospital A. C. Camargo. Manual de condutas diagnósticas e terapêuticas em oncologia. Säo Paulo, Ambito Editores, 1996. p.261-261.
Idioma: pt.
Descritores: Neoplasias Nasofaríngeas
-Neoplasias Nasofaríngeas/classificação
Neoplasias Nasofaríngeas/diagnóstico
Neoplasias Nasofaríngeas/terapia
Limites: Seres Humanos
Responsável: BR1.1 - BIREME
BR1.1/2734.38; BR75.1; 616-006, M319. 3053


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Id: lil-180272
Autor: Gorender, Ethel Fernandes.
Título: Tumores raros na infância / Rare tumors in childhood
Fonte: In: Fundaçäo Antonio Prudente. Hospital A. C. Camargo. Manual de condutas diagnósticas e terapêuticas em oncologia. Säo Paulo, Ambito Editores, 1996. p.174-174.
Idioma: pt.
Descritores: Neoplasias do Córtex Suprarrenal/diagnóstico
Neoplasias do Córtex Suprarrenal/terapia
Neoplasias Nasofaríngeas/diagnóstico
Neoplasias Nasofaríngeas/terapia
Limites: Seres Humanos
Masculino
Feminino
Recém-Nascido
Lactente
Pré-Escolar
Criança
Responsável: BR1.1 - BIREME
BR1.1/2734.27; BR75.1; 616-006, M319. 3053


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Texto completo SciELO Chile
Texto completo
Id: biblio-902773
Autor: Rahal E, Maritza; Sepúlveda S, René; Gajardo O, Pilar; Arregui V, Rodrigo.
Título: Fibroangioma nasofaríngeo juvenil: experiencia de 15 años en el Hospital Barros Luco Trudeau / Juvenile nasopharyngeal fibroangioma: the experience of 15 years in Hospital Barros Luco Trudeau
Fonte: Rev. otorrinolaringol. cir. cabeza cuello;77(3):252-258, set. 2017. tab, ilus.
Idioma: es.
Resumo: Introducción: El fibroangioma nasofaríngeo juvenil es un tumor vascular benigno localmente agresivo, que afecta casi exclusivamente la nasofaringe de adolescentes de sexo masculino. Su manejo es complejo dada su extensión, naturaleza vascular y sus frecuentes recurrencias. Objetivo: Mostrar la experiencia de 15 años en fibroangioma juvenil en nuestro centro. Material y método: Estudio descriptivo retrospectivo de los pacientes con diagnóstico de ingreso de fibroangioma nasofaríngeo juvenil al Servicio de Otorrinolaringología del Hospital Barros Luco Trudeau entre los años 1997 y 2011, caracterizando al grupo de estudio en cuanto a características clínico-demográficas, vasos aferentes, relación entre etapa tumoral y vascularización, manejo terapéutico, complicaciones y recurrencias. Resultados: Se obtuvo un total de 20 pacientes, todos de sexo masculino, con un promedio de edad de 13,9 años. El síntoma de presentación más frecuente fue la epistaxis a repetición y obstrucción nasal presente en el 90% y 80%, respectivamente. Todos los pacientes se estudiaron con tomografia computarizada y recibieron embolización arterial preoperatoria. La mayoría de los tumores fueron de tipo II (65%) y III (20%), según clasificación de Radkowski. La técnica quirúrgica más empleada fue abierta (57,8%). Radioterapia en un caso. El vaso aferente principal fue la maxilar interno ipsilateral en el 100%. Todos los fibroangiomas etapa III eran además irrigados por la arteria carótida interna. Se encontró 20% de persistencia y 15% de recidiva. Conclusión: Nuestros resultados concuerdan con la gran mayoría de las series publicadas en la literatura. Epistaxis recurrente, obstrucción nasal y tumor nasal unilateral deben hacernos sospechar de esta patología en un adolescente masculino. El tratamiento de elección es la cirugía con embolización preoperatoria. La vía de abordaje endoscópica presenta menor morbilidad posoperatoria en pacientes con estadios I y II de Radkowski. Todos los fibroangiomas con compromiso intracraneano, presentan irrigación también del sistema carotideo interno.

Introduction: Nasopharyngeal Fibroangioma is a locally aggressive benign vascular tumor. Its management is complex given its size, vascular nature and its frequent recurrences. Aim: To show the experience of 15 years in Juvenile Fibroangioma in our center. Material and method: Retrospective descriptive study of patients admitted with a diagnosis of Juvenile Fibroangioma Nasopharyngeal in the Department of Otolaryngology Hospital Barros Luco Trudeau between 1997 and 2011. Results: A total of 20 patients was obtained. The most common presenting symptom was recurrent epistaxis and nasal obstruction present in 90% and 80% respectively. The most common surgical technique was open (57.8%). Radiotherapy in one case. The main afferent vessel was the ipsilateral internal maxillary in 100%. All Fibroangioma stage III were also supplied by the internal carotid artery. 20% of persistence and 15% of recurrence was found. Conclusion: Recurrent epistaxis, nasal obstruction and unilateral nasal tumor should raise the suspicion of this disease in a male teenager. The treatment of choice is surgery with preoperative embolization. The route of endoscopic approach has less postoperative morbidity in patients with stage I and II of Radkowski. All Fibroangioma with intracranial commitment, have also the internal carotid irrigation system.
Descritores: Neoplasias Nasofaríngeas/terapia
Angiofibroma/terapia
-Angiografia
Obstrução Nasal/etiologia
Epistaxe/etiologia
Neoplasias Nasofaríngeas/cirurgia
Neoplasias Nasofaríngeas/patologia
Neoplasias Nasofaríngeas/diagnóstico por imagem
Estudos Retrospectivos
Angiofibroma/cirurgia
Angiofibroma/patologia
Angiofibroma/diagnóstico por imagem
Embolização Terapêutica
Endoscopia
Estadiamento de Neoplasias
Limites: Seres Humanos
Masculino
Criança
Adolescente
Adulto Jovem
Responsável: CL1.1 - Biblioteca Central


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Id: biblio-909906
Autor: Pucella, María Inés; Gadan, Cecilia; Sardi, Mabel; Del Valle Jaen, Ana; Figari, Marcelo; Lastiri, José María; Cayol, Federico.
Título: Cáncer de cavum. Experiencia institucional / Cancer of cavum. Institutional experience
Fonte: Oncol. clín;23(1):22-26, 2018.
Idioma: es.
Resumo: Los carcinomas epidermoides de cabeza y cuello son un grupo poco frecuente de neoplasias, en los Estados Unidos representan aproximadamente el 3% de todos los tumores. El cáncer de cavum se diferencia de otros tumores de cabeza y cuello por su epidemiología, histología, historia natural y respuesta al tratamiento. Presenta una marcada variación geográfica debido a su etiología multifactorial. En las áreas endémicas, la incidencia y la mortalidad han disminuido en los últimos 30 años. Esto probablemente se deba a cambios en el estilo de vida y avances en la radioterapia (RT) y quimioterapia (QT) sistémica (AU)

Epidermoid carcinomas of the head and neck are a rare group of tumors, in the United States they account for 3% of all cancers. Nasopharyngeal carcinoma differs from others head and neck squamous cells carcinomas in epidemiology, natural history, and response to treatment. Nasopharyngeal carcinoma displays a distinct racial and geographic distribution, which is reflective of its multifactorial etiology. The incidence and mortality has declined over the past 30 years in many endemic areas. This finding is probably a result of a combination of lifestyle modification and advances in radiotherapy and effective systemic agents (AU)
Descritores: Infecções por Vírus Epstein-Barr
Neoplasias Nasofaríngeas/terapia
-Quimiorradioterapia
Quimiorradioterapia Adjuvante
Limites: Seres Humanos
Masculino
Feminino
Meia-Idade
Responsável: AR144.1 - CIBCHACO - Centro de Información Biomedica del Chaco


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Id: biblio-908896
Autor: Morales, G; Morales, G N; González Macchi, M E; De Bagge, M; Fauqué, L E; Gerard, A; Bernáldez, P C.
Título: Fibroangioma nasofaríngeo juvenil. Experiencia en 89 pacientes / Juvenile nasopharyngeal angiofibroma. An experience of 89 patients
Fonte: Med. infant;25(2):103-110, Junio 2018. ilus.
Idioma: es.
Resumo: El fibroangioma nasojuvenil (FANJ) es un tumor benigno, localmente invasivo, que se presenta en varones púberes y adolescentes. Se manifiesta clínicamente por insuficiencia ventilatoria nasal progresiva y epistaxis. Con el objetivo de describir las características clínico quirúrgicas se realizó un estudio observacional, retrospectivo, transversal de los FANJ intervenidos quirúrgicamente en el período enero 2000 a diciembre 2017 en el Hospital de Pediatría Juan P. Garrahan. Resultados: se incluyeron 89 pacientes con diagnóstico de fibroangioma nasojuvenil intervenidos quirúrgicamente. El 71% de los pacientes menores de 14 años. El síntoma predominante fue epistaxis en el 91% de los casos. El 80,1% (72/89) estaban incluidos en los estadios III y IV de Chandler presentando digitaciones a fosa pterigomaxilar y senos paranasales. El 29,2% (26/89) de los casos presentaba invasión a endocráneo. En el 96% (86/89) se realizó embolización prequirúrgica de las ramas nutricias del tumor. Los abordajes quirúrgicos más utilizados fueron: la vía transantral en el 43,8% (39/89), abordaje de Le Fort 1 en el 21,3% (19/89), endoscópico en el 12,3% (11/89), abordaje combinado con neurocirugía en el 12,3% (11/89) de los pacientes. La recurrencia fue de 33,7% y no hubo pacientes fallecidos. Conclusiones: El fibroangioma nasojuvenil es una patología tumoral que requiere para su resolución un equipo multidisciplinario en instituciones con infraestructura de alta complejidad. El abordaje quirúrgico debe seleccionarse de acuerdo a la localización y extensión tumoral, la efectividad de la embolización previa, la edad del paciente y la experiencia del equipo quirúrgico (AU)

Juvenile nasopharyngeal angiofibroma (JNA) is a benign, locally invasive tumor, occurring in pubertal and adolescent males. Clinically the tumor manifests with progressive nasal obstruction and epistaxis. With the aim to describe the clinical and surgical features, an observational, retrospective, cross-sectional study was conducted in patients with JNA who underwent surgery at Hospital de Pediatría Juan P. Garrahan between January 2000 and December 2017. Results: Overall, 89 patients diagnosed with JNA who underwent surgery were included; 71% were under 14 years of age. The main symptom was epistaxis occurring in 91% of the cases. Of all patients, 80.1% (72/89) were in Chandler stages III and IV with extension into the pterygomaxillary fossa and paranasal sinuses. Intracranial invasion was found in 29.2% (26/89) of the cases. In 96% (86/89), preoperative embolization of the feeding branches of the tumor was performed. The most commonly used surgical approaches were: The transantral approach in 43.8% (39/89), Le Fort 1 in 21.3% (19/89), endoscopic approach in 12.3% (11/89), and an approach combined with neurosurgery in 12.3% (11/89) of patients. Recurrence rate was 33.7% and none of the patients died. Conclusions: Management of JNA a multidisciplinary team at a tertiary care institution. The surgical approach should be selected according to tumor location and extension, effectiveness of previous embolization, the patient age, and expertise of the surgical team (AU)
Descritores: Angiofibroma/cirurgia
Neoplasias Nasofaríngeas/cirurgia
Estadiamento de Neoplasias
-Angiofibroma/diagnóstico
Estudos Transversais
Epistaxe
Neoplasias Nasofaríngeas/diagnóstico
Estudo Observacional
Estudos Retrospectivos
Limites: Seres Humanos
Masculino
Criança
Adolescente
Tipo de Publ: Relatos de Casos
Responsável: AR305.1 - SID - Servicio de Información y Documentación


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Id: biblio-908142
Autor: González Macchi, Emilia; Sommerfleck, Patricia; De Bagge, Maximiliano; Morales, Guillermo.
Título: Evolución en la técnica quirúrgica endoscópica para la cirugía del fibroangioma. Nuestra experiencia / Evolution in endoscopic surgical technique for fibroangioma surgery. Our experience / Evolução em cirurgia endoscópica cirurgia técnica fibroangioma. A nossa experiência
Fonte: Rev. Fed. Argent. Soc. Otorrinolaringol;24(2):43-47, 2017. ilus.
Idioma: es.
Resumo: El fibroangioma nasofaríngeo juvenil es una neoplasia vascular benigna poco frecuente, que afecta exclusivamente al sexo masculino. Para su tratamiento la cirugía es la alternativa más aceptada. Existen diversas técnicas quirúrgicas para su resolución. En la actualidad la cirugía endoscópica permite resolver prácticamente todos los estadios del fibroangioma. En 5 años nuestro servicio realizó 53 cirugías de fibroangioma, siendo progresiva la incorporación del endoscopio, que primeramente se utilizó para las recidivas, y paulatinamente se logró realizar abordajes completos con esta técnica. Es importante tener en cuenta que la curva de aprendizaje es fundamental para lograr dichos avances quirúrgicos.

The juvenile nasopharyngeal fibroangioma is arare benign vascular tumor that affects only males.Treatment for surgery is the most accepted alternative.There are several surgical techniques for resolution.Currently endoscopic surgery can solve allstages of the nasopharyngeal fibroangioma. In 5 years our service performed 53 surgeries ofnasopharyngeal fibroangioma, being progressivethe incorporation of the endoscope, which wasfirst used for recurrence, and gradually managed tomake complete approaches to this technique.It is important to note that the learning curve is criticalto obtaining these surgical advances.

O fibroangioma nasofaríngeo juvenil é um tumor vascular benigno raro que afeta apenas os machos.O tratamento para a cirurgia é a alternativa mais amplamente aceito. Existem várias técnicas cirúrgicas para resolução. Atualmente a cirurgia endoscópica pode resolver praticamente todos os estágios de fibroangioma.Em5anosonosso fibroangiomaserviçorealizado53 cirurgias, sendo incorporação progressiva do endoscópio, que é usado pela primeira vez para a recaídas e, gradualmente, conseguiu fazer abordagens abrangentes para esta técnica. É importante notar que a curva de aprendizagem é fundamental para alcançar esses avanços cirúrgicos.
Descritores: Neoplasias Nasofaríngeas
-Epistaxe/terapia
Neoplasias Nasofaríngeas
Cirurgia Endoscópica por Orifício Natural/métodos
Cirurgia Endoscópica por Orifício Natural
Limites: Masculino
Seres Humanos
Adolescente
Criança
Tipo de Publ: Estudos de Avaliação
Relatos de Casos
Revisão
Estudos de Avaliação
Relatos de Casos
Revisão
Responsável: AR635.1 - FCVyS - Servicio de Información y Documentación


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Texto completo SciELO Brasil
Texto completo
Id: biblio-888976
Autor: Jiang, T; Jiang, CY; Shu, JH; Xu, YJ.
Título: Excavation of attractor modules for nasopharyngeal carcinoma via integrating systemic module inference with attract method
Fonte: Braz. j. med. biol. res = Rev. bras. pesqui. méd. biol;50(8):e6416, 2017. tab, graf.
Idioma: en.
Resumo: The molecular mechanism of nasopharyngeal carcinoma (NPC) is poorly understood and effective therapeutic approaches are needed. This research aimed to excavate the attractor modules involved in the progression of NPC and provide further understanding of the underlying mechanism of NPC. Based on the gene expression data of NPC, two specific protein-protein interaction networks for NPC and control conditions were re-weighted using Pearson correlation coefficient. Then, a systematic tracking of candidate modules was conducted on the re-weighted networks via cliques algorithm, and a total of 19 and 38 modules were separately identified from NPC and control networks, respectively. Among them, 8 pairs of modules with similar gene composition were selected, and 2 attractor modules were identified via the attract method. Functional analysis indicated that these two attractor modules participate in one common bioprocess of cell division. Based on the strategy of integrating systemic module inference with the attract method, we successfully identified 2 attractor modules. These attractor modules might play important roles in the molecular pathogenesis of NPC via affecting the bioprocess of cell division in a conjunct way. Further research is needed to explore the correlations between cell division and NPC.
Descritores: Carcinoma/genética
Regulação Neoplásica da Expressão Gênica/genética
Redes Reguladoras de Genes/genética
Neoplasias Nasofaríngeas/genética
-Perfilação da Expressão Gênica
Mapeamento de Interação de Proteínas
Limites: Seres Humanos
Responsável: BR1.1 - BIREME


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Texto completo SciELO Brasil
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Id: lil-787428
Autor: Yuan, Jing; Xu, Miao; Li, Jing; Li, Ning; Chen, Li-Zhen; Feng, Qi-Sheng; Zeng, Yi-Xin.
Título: Prognostic value of cystatin C in patients with nasopharyngeal carcinoma: a retrospective study of 1063 patients
Fonte: Clinics;71(6):338-343tab, graf.
Idioma: en.
Resumo: OBJECTIVE: Patients with nasopharyngeal carcinoma experience highly variable outcomes despite receiving similar therapeutic regimens. Identifying biomarkers that predict survival and guide individualized therapy is urgently needed. Cystatin C has been explored as a valuable prognostic marker in several malignancies. We retrospectively assessed the relationship between serum cystatin C levels and nasopharyngeal carcinoma prognosis in a large cohort of nasopharyngeal carcinoma patients receiving long-term follow-up. METHODS: A total of 1063 consecutive patients diagnosed with nasopharyngeal carcinoma from June 2006 to December 2010 were retrospectively analyzed. The serum levels of cystatin C at the time of diagnosis were collected. Receiver operating characteristic curve analysis, the Kaplan-Meier method and multivariate analyses using a Cox regression model were performed to assess the correlation of cystatin C levels with overall survival, progression-free survival, distant metastasis-free survival and loco-regional recurrence-free survival. RESULTS: The median follow-up duration was 68.3 months. The optimal cut-off value of cystatin C levels for predicting death was 0.945 mg/L. Compared with the low cystatin C group, the high cystatin C group experienced significantly shorter overall survival (hazard ratio=1.47, p=0.050), progression-free survival (hazard ratio=1.65, p=0.004), distant metastasis-free survival (hazard ratio=2.37, p<0.001) and loco-regional recurrence-free survival (hazard ratio=2.40, p=0.002). Based on multivariate analysis, a high cystatin C level was identified as a significant and independent negative predictor of overall survival (hazard ratio=1.47, p=0.050), progression-free survival (hazard ratio=1.65, p=0.004), distant metastasis-free survival (hazard ratio=2.37, p<0.001), and loco-regional recurrence-free survival (hazard ratio=2.40, p=0.002). CONCLUSION: Cystatin C levels are associated with the prognosis of nasopharyngeal carcinoma patients. A high cystatin C level is an independent indicator of poor prognosis for nasopharyngeal carcinoma patients.
Descritores: Biomarcadores Tumorais/sangue
Carcinoma/sangue
Cistatina C/sangue
Neoplasias Nasofaríngeas/sangue
-Intervalo Livre de Doença
Seguimentos
Análise Multivariada
Prognóstico
Estudos Retrospectivos
Análise de Sobrevida
Fatores de Tempo
Limites: Seres Humanos
Masculino
Feminino
Meia-Idade
Responsável: BR1.1 - BIREME



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