Prognostic risk factors in patients with jaw osteoradionecrosis: A retrospective cohort study at a tertiary teaching hospital
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Published on: August 22, 2022
Chen-Xi Li1, Zhong-Cheng Gong2, Sakendeke Jumatai3
1Department of Oral and Maxillofacial Oncology & Surgery, School/Hospital of Stomatology, The First Affiliated Hospital of Xinjiang Medical University, National Clinical Medical Research Institute, Urumqi, Xinjiang Uygur Autonomous Region, China; Stomatological Research Institute of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China; Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong Province, China; Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China; Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong Province, China.
Background/Objective:
Osteoradionecrosis of the jaws (ORNJ) is a severe complication of radiotherapy for head and neck cancer, with limited data on prognostic factors. This study aimed to identify risk factors associated with wound healing prognosis in ORNJ patients.
Methods:
A retrospective cohort study was conducted following STROBE guidelines, including 106 ORNJ patients treated at a tertiary hospital between 2005 and 2020. Patients were divided into normal wound healing (NH, within 7-10 days postoperatively) and delayed wound healing (DH, ≥11 days postoperatively) groups. Univariate analysis, multivariate Logistic regression, and Cox proportional hazards models were used to identify prognostic factors.
Results:
The median follow-up was 38.6 months. Univariate analysis showed DH patients had significantly higher baseline PIV (median: 490.1 vs 437.8) and SII (median: 775.6 vs 732.2) than NH patients (all p < 0.001). Multivariate logistic regression showed that diabetes mellitus (OR = 9.687, p = 0.010), Charlson comorbidity index (CCI, OR = 10.004, p < 0.001), primary tumor site (OR = 10.384, p = 0.006), T stage (OR = 27.340, p < 0.001), ORNJ grade at diagnosis (OR = 4.367, p < 0.001), pan-immune-inflammatory value (PIV, OR = 1.043, p < 0.001), and systemic immune-inflammatory index (SII, OR = 1.023, p < 0.001) were independent risk factors for delayed healing. Kaplan-Meier curves showed that patients in the highest PIV tertile had significantly longer time-to-healing (median: 31.5 vs 18.3 days, Log-rank p < 0.001).
Conclusions:
PIV and SII, along with clinical factors (diabetes mellitus, CCI, T stage, ORNJ grade), are independent prognostic factors for wound healing in ORNJ patients. These findings may help clinicians optimize treatment strategies and predict outcomes.
