Combining pan-immune-inflammation value and pretreatment tooth extractions in predicting osteoradionecrosis of the jaw: A pilot study

Abstract

Previously, we demonstrated that the pan-immune-inflammation value (PIV) and pretreatment tooth extraction (TE) were independent predictors of osteoradionecrosis of the jaws (ORNJ) in patients with locally advanced nasopharyngeal carcinoma (LA-NPC) undergoing concurrent chemoradiotherapy (C-CRT). This study aimed to determine if combining PIV and TE, termed the PIV-TE-ORNJ index, and could improve the prediction of ORNJ prevalence in the same scenario. We divided patients into two groups based on each factor, with the PIV and TE cutoffs at 833 and 4, respectively, as determined in our previous study. The novel PIV-TE-ORNJ index, which combined these factors, revealed four probable groups: Group 1, PIV < 833 and TE < 4; Group 2, PIV < 833 but TE ≥ 4; Group 3, TE < 4 but PIV ≥ 833; and Group 4, PIV ≥ 833 and TE ≥ 4. The medical records of 220 patients with LA-NPC were reviewed retrospectively. Comparisons between four groups revealed that the ORNJ rates for Groups 1 - 4 were 1.1%, 6.6%, 6.1%, and 43.8%, respectively (P < 0.001). Because the ORNJ rates in Groups 2 and 3 were interchangeable (P = 0.91), these groups were merged, and a three-tiered novel PIV-TE-ORNJ index was created: low risk, PIV < 833 and TE < 4; intermediate risk, PIV < 833 but TE ≥ 4, or TE < 4 but PIV ≥ 833; and high risk, PIV ≥ 833 and TE ≥ 4. Comparisons between the three groups demonstrated that the low- and high-risk groups had the lowest (1.1%) and highest (43.8%) ORNJ rates, respectively, whereas the ORNJ rate of the intermediate-risk group was in between (6.4%) (P < 0.001 for each). The PIV-TE-ORNJ index successfully stratified patients with LA-NPC into low-, intermediate-, and high-risk groups after C-CRT.

Keywords

Tooth extraction / Pan-immune-inflammation value / Nasopharyngeal cancer / Concurrent chemoradiotherapy / Osteoradionecrosis

Acknowledgments

None.

Funding

None.

Conflict of interest

The authors declare that they have no competing interests.

Author contributions

Conceptualization: All authors

Formal analysis: All authors

Investigation: All authors

Methodology: All authors

Writing-original draft: All authors

Writing-review & editing: All authors

Ethics approval and consent to participate

Baskent University Medical Faculty’s Institutional Review Board (IRB No. DKA 19/39) approved the retrospective investigation before collecting patient data. This investigation was carried out in accordance with the principles outlined in the Helsinki Declaration and its later amendments. Before the C-CRT commenced, all participants provided written informed consent for collecting and publishing associated outcomes, as required by our institution’s policies and procedures.

Consent for publication

We ensured that all patients signed an informed consent form before the beginning of the evaluation, either themselves or their legally authorized representatives for acquisition and analysis of the patient’s sociodemographic, dental, and medical records; blood samples, and publication of the outcomes.

Availability of data

Data cannot be shared publicly because it is owned and saved by the Baskent University Medical Faculty. However, for researchers who meet the criteria for access to confidential data, data are available from the Baskent University Institutional Data Access/Ethics Committee (contact through Baskent University Ethics Committee): contact address, [e-mail].

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