氧合-营养-炎症（ONI）指数与局部晚期鼻咽癌患者颌骨放射性骨坏死风险：一项连续多维建模分析

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中文摘要

背景： 颌骨放射性骨坏死（ORNJ）仍是接受根治性同步放化疗（CCRT）的局部晚期鼻咽癌（LA-NPC）患者的主要晚期并发症，而当前基于剂量学和牙科因素的风险模型不能完全解释个体间差异。为解决这一局限，我们在连续建模框架内评估了一种由血红蛋白、白蛋白和C反应蛋白衍生的新型氧合-营养-炎症（ONI）指数与ORNJ风险之间的关联。
方法： 回顾性分析298例接受CCRT治疗的LA-NPC患者。收集临床、牙科和剂量学变量。ONI按复合炎症-营养生物标志物计算。采用单变量和多变量logistic回归分析评估ONI及已确立临床因素与ORNJ的独立关联。
结果： 25例（8.4%）患者发生ORNJ。发生ORNJ的患者下颌骨平均辐射剂量更高、拔牙数更多，同时ONI值显著更低。在多变量分析中，下颌骨平均剂量（每Gy OR 1.23，95% CI 1.13-1.34；p < 0.001）、拔牙数（每颗牙OR 1.38，95% CI 1.12-1.70；p = 0.002）和ONI（每单位增加OR 0.88，95% CI 0.78-0.99；p = 0.036）仍与ORNJ独立相关。ORNJ发生率随ONI三分位升高而下降（17.2%、6.1%和2.0%；p < 0.001），支持ONI与ORNJ风险之间的反向关系。
结论： ORNJ似乎反映了涉及辐射剂量、牙科创伤和全身宿主易感性的多因素过程。ONI与ORNJ风险独立相关，可能有助于个体化风险分层，尽管这些发现应被视为假设生成性结果并需要外部验证。

英文摘要

BACKGROUND: Osteoradionecrosis of the jaw (ORNJ) remains a major late complication in patients with locally advanced nasopharyngeal carcinoma (LA-NPC) treated with definitive concurrent chemoradiotherapy (CCRT), for which current risk models based on dosimetric and dental factors do not fully explain inter-individual variability. To address this limitation, we evaluated the association between a novel Oxygenation-Nutritional-Inflammatory (ONI) index, derived from hemoglobin, albumin, and C-reactive protein, and ORNJ risk within a continuous modeling framework.
METHODS: A total of 298 LA-NPC patients treated with CCRT were retrospectively analyzed. Clinical, dental, and dosimetric variables were collected. ONI was calculated as a composite inflammatory-nutritional biomarker. Univariable and multivariable logistic regression analyses were performed to evaluate the independent associations of ONI and established clinical factors with ORNJ.
RESULTS: ORNJ occurred in 25 (8.4%) patients. Patients who developed ORNJ had higher mandibular mean radiation dose and more extracted teeth, along with significantly lower ONI values. In multivariable analysis, mandibular mean dose (OR 1.23 per Gy, 95% CI 1.13-1.34; p < 0.001), number of extracted teeth (OR 1.38 per tooth, 95% CI 1.12-1.70; p = 0.002), and ONI (OR 0.88 per unit increase, 95% CI 0.78-0.99; p = 0.036) remained independently associated with ORNJ. ORNJ incidence decreased across increasing ONI tertiles (17.2%, 6.1%, and 2.0%; p < 0.001), supporting an inverse relationship between ONI and ORNJ risk.
CONCLUSIONS: ORNJ appears to reflect a multifactorial process involving radiation dose, dental trauma, and systemic host vulnerability. ONI was independently associated with ORNJ risk and may contribute to individualized risk stratification, although these findings should be considered hypothesis-generating and require external validation.