Department of Oral Maxillofacial & Head and Neck Oncology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Zhi-zao-ju Rd, No. 639, Shanghai, 200011, China.
Department of Stomatology, The Second Affiliated Hospital of Soochow University, San-xiang Rd, No. 1055, Suzhou, Jiangsu Province, 215004, China.
J Craniomaxillofac Surg. 2018 Nov;46(11):1960-1967. doi: 10.1016/j.jcms.2018.08.010. Epub 2018 Aug 24.
Osteoradionecrosis of the mandible (ORNM) is one of the most devastating complications following radiotherapy. Postoperative relapse (POR) occurs with high incidence even if a radical resection is performed. The current investigation was designed to identify prognostic factors for POR and to establish a nomogram model to estimate the risk for the onset of POR of ORNM.
A retrospective study was conducted in ORNM patients during the period from 2003 to 2016. Predictive factors for POR were preliminarily filtered by Kaplan-Meier analysis and were further confirmed by Cox regression model. A nomogram model was established to predict the risk for the onset of POR, and the performance was estimated by receiver operating characteristic (ROC) and calibration curve. POR was defined as the primary outcome variable and was measured using univariate and multivariate analyses.
A total of 213 patients were analyzed, and the total incidence of POR was 24.4% (52/213). In the Cox regression analysis, radiation doses ≥80 Gy (versus＜80 Gy, OR = 3.528, P＜0.001, 95% CI: 1.759-7.076), location of ORNM (lesion only in mandibular body versus that involving mandibular body, angulus and ramus versus, OR = 2.900, P = 0.007, 95% CI: 1.345-6.253), S classification (S2 versus S0, OR = 8.926, P = 0.001, 95% CI: 2.487-32.036), and surgical treatment (sequestretomy versus ER + reconstruction, OR = 3.299, P = 0.012, 95% CI: 1.294-8.411) were significantly associated with POR. The current nomogram model can effectively evaluate the hazard risk and survival rate of POR. The discrimination capability was tested by the ROC curve with an area under the curve of 0.813, revealing highly predictive abilities. The calibration curve showed sufficient fitness.
The current nomogram model was effective in predicting the risk of POR in ORNM patients.
下颌骨放射性骨坏死（ORNM）是放疗后最具破坏性的并发症之一。即使进行根治性切除，术后复发（POR）的发生率也很高。本研究旨在确定 POR 的预后因素，并建立诺莫图模型来估计 ORNM 的 POR 发病风险。
回顾性分析 2003 年至 2016 年期间 ORNM 患者的资料。通过 Kaplan-Meier 分析初步筛选 POR 的预测因素，并通过 Cox 回归模型进一步确认。建立诺莫图模型预测 POR 的发病风险，并通过接受者操作特征（ROC）曲线和校准曲线来评估其性能。POR 定义为主要结局变量，并通过单因素和多因素分析进行测量。
共分析了 213 例患者，POR 的总发生率为 24.4%（52/213）。在 Cox 回归分析中，放射剂量≥80 Gy（与＜80 Gy 相比，OR=3.528，P＜0.001，95%CI：1.759-7.076）、ORNM 部位（仅下颌体病变与下颌体、角部和升支均受累相比，OR=2.900，P=0.007，95%CI：1.345-6.253）、S 分级（S2 与 S0 相比，OR=8.926，P=0.001，95%CI：2.487-32.036）和手术治疗（病灶清除术与 ER+重建术相比，OR=3.299，P=0.012，95%CI：1.294-8.411）与 POR 显著相关。目前的诺莫图模型可以有效地评估 POR 的危险风险和生存率。ROC 曲线下面积为 0.813，表明具有较高的预测能力，验证了其区分能力。校准曲线显示具有足够的拟合度。
目前的诺莫图模型能有效预测 ORNM 患者 POR 的发病风险。
