Mechanism of skull base osteoradionecrosis explored through laboratory assessment with propensity score-matched...

Skull base osteoradionecrosis (sbORN) is a severe complication of radiotherapy (RT) in patients with nasopharyngeal carcinoma (NPC) that can severely affect quality of life (QOL) and may even be life-threatening. The etiology and pathogenesis of sbORN remain largely unknown or uncertain. Therefore, this study aimed to identify potential risk factors for sbORN by analyzing the laboratory assessments of patients to enable early clinical interventions. This retrospective case-control study reviewed NPC patients who were pathologically diagnosed with sbORN after primary radical radiotherapy. These patients were matched 1:1 with propensity scores for patients without sbORN at our center. The impact of laboratory examination indexes on sbORN occurrence was assessed using both univariate and multivariate logistic regression analyses. We reviewed 1,200 NPC patients who were followed up in our department from 2010 to 2020; a total of 57 patients met the inclusion criteria. Each patient underwent endoscopic and pathological examinations, which confirmed the diagnosis. In addition, 98 patients without sbORN were also collected and matched 1:1 by propensity score matching, resulting in the inclusion of 38 patients. Univariate logistic regression analysis revealed statistically significant differences in hemorrhage (HB), erythrocytes (RBC), albumin (Alb), platelets (PLT), indirect bilirubin (IBil), globulin (Glo), aspartate aminotransferase (AST), and fibrinogen (Fg) between the two groups (p < 0.05). Multivariate logistic regression analysis revealed statistically significant differences only for Fg (p < 0.05). Receiver operating characteristic (ROC) curve analysis further demonstrated the diagnostic utility of Fg, yielding an area under the curve (AUC) of 0.829, with specificity and sensitivity values of 0.842 and 0.711, respectively. The occurrence of sbORN was closely associated with elevated plasma Fg levels, suggesting that high plasma Fg may be a potential risk factor for sbORN. Plasma Fg has a certain diagnostic value for sbORN and can be used as a supplementary diagnostic method.