背景:这项回顾性研究旨在研究预处理血小板(PLT)水平是否可以预测接受同步放化疗(CCRT)的局部晚期鼻咽癌(LA-NPC)患者的颌骨放射性坏死(ORNJ)的风险。
■从LA-NPC患者的CCRT口试记录中发现了ORNJ实例。在CCRT的第一天获得所有预处理PLT值。使用受试者工作特征曲线分析来确定将患者分为具有独特ORNJ率的两个亚组的最佳PLT截止值。主要结果指标是治疗前PLT值与ORNJ发病率之间的关联。
结果:在分析的240例LA-NPC患者中,ORNJ的发生率为8.8%。将患者分为两个显着不同的ORNJ速率组的理想CCRT前PLT截止值为285,000个细胞/μL(PLT≤285,000个细胞/μL(N=175)与PLT>285,000个细胞/微升(N=65))。两个PLT组的比较显示,PLT>285,000细胞/L的患者ORNJ的发生率明显高于PLT≤285,000细胞/L的患者(26.2%vs.2.3%;P<0.001)。存在预CCRT≥3次拔牙,任何后CCRT拔牙,平均下颌剂量≥34.1Gy,下颌V57.5Gy≥34.7%,CCRT完成后>9个月的CCRT拔牙也与ORNJ率显著增加相关。多变量Cox回归分析表明,CCRT后每个特征对ORNJ率具有独立的意义。
结论:一种经济实惠且易于获取的新型生物标志物,PLT>285,000细胞/L,在LA-NPC患者中,经过明确的CCRT后,可能会预测更高的ORNJ率。
BACKGROUND: This retrospective study aimed to investigate if pretreatment platelet (PLT) levels can predict the risk of osteoradionecrosis of the jaw (ORNJ) in patients with locally advanced nasopharyngeal carcinoma (LA-NPC) who received concurrent chemoradiotherapy (CCRT).
UNASSIGNED: ORNJ instances were identified from LA-NPC patients\' pre- and post-CCRT oral exam records. All pretreatment PLT values were acquired on the first day of CCRT. Receiver operating characteristic curve analysis was used to determine the optimal PLT cutoff that divides patients into two subgroups with distinctive ORNJ rates. The primary outcome measure was the association between pretreatment PLT values and ORNJ incidence rates.
RESULTS: The incidence of ORNJ was 8.8 % among the 240 LA-NPC patients analyzed. The ideal pre-CCRT PLT cutoff which divided the patients into two significantly different ORNJ rate groups was 285,000 cells/µL (PLT ≤ 285,000 cells/µL (N = 175) vs. PLT > 285,000 cells/µL (N = 65)). A comparison of the two PLT groups revealed that the incidence of ORNJ was substantially higher in patients with PLT > 285,000 cells/L than in those with PLT≤285,000 cells/L (26.2% vs. 2.3 %; P < 0.001). The presence of pre-CCRT ≥3 tooth extractions, any post-CCRT tooth extractions, mean mandibular dose ≥ 34.1 Gy, mandibular V57.5 Gy ≥ 34.7 %, and post-CCRT tooth extractions > 9 months after CCRT completion were also associated with significantly increased ORNJ rates. A multivariate Cox regression analysis demonstrated that each characteristic had an independent significance on ORNJ rates after CCRT.
CONCLUSIONS: An affordable and easily accessible novel biomarker, PLT> 285,000 cells/L, may predict substantially higher ORNJ rates after definitive CCRT in individuals with LA-NPC.