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A nomogram to predict osteoradionecrosis in oral cancer after marginal mandibulectomy and radiotherapy.

预测边缘下颌骨切除术和放疗后口腔癌放射性骨坏死的列线图。

  • 影响因子:2.32
  • DOI:10.1002/lary.27870
  • 作者列表:"Renda L","Tsai TY","Huang JJ","Ito R","Hsieh WC","Kao HK","Hung SY","Huang Y","Huang YC","Chang YL","Cheng MH","Chang KP
  • 发表时间:2020-01-01
Abstract

OBJECTIVE:There is no useful tool to clinically predict the occurrence of osteoradionecrosis (ORN) of the mandible quantitatively. The aim was to investigate the risk factors, including different modalities of radiotherapy, for developing mandibular ORN in patients undergoing marginal mandibulectomy and postoperative radiotherapy. METHODS:Between January 2006 and December 2012, 167 subjects who underwent marginal mandibulectomy and postoperative radiotherapy with different modalities were enrolled. The association of ORN with mandibular bone measurements and patient variables was analyzed, and a nomogram was established. RESULTS:Fifteen (8.98%) of the 167 patients developed ORN during the follow-up period, and ORN was significantly associated with diabetes mellitus (DM), body mass index (BMI), remaining bone height, remaining bone height to original bone height ratio, resected bone height to original bone height ratio, and mandibular dose (P: < 0.001, 0.004, 0.042, 0.018, 0.010, 0.020, respectively). Interestingly, the risk of ORN had no significant difference between conformal and intensity modulation radiation therapy (P = 0.407). Multivariate analysis revealed that DM and resected bone height to original bone height ratio ≥ 50% were independent risk factors for postoperative ORN. A nomogram consisting of BMI, DM, resected bone height to original bone height ratio, mandibulotomy, and mandibular dose for predicting the ORN-free probability was established; and the c-index of the nomogram for ORN status was 0.803. CONCLUSION:A nomogram based on the risk factors was plotted to strengthen the prediction of ORN quantitatively. Surgeons should be more discrete regarding the treatment plan for patients with higher probability of ORN. LEVEL OF EVIDENCE:3b Laryngoscope, 130:101-107, 2020.

摘要

目的: 临床上没有有用的工具来定量预测下颌骨放射性骨坏死 (ORN) 的发生。目的是调查接受边缘性下颌骨切除术和术后放疗患者发生下颌ORN的危险因素,包括不同的放疗方式。 方法: 2006 年 1 月至 2012 年 12 月,167 例接受不同方式的下颌骨边缘切除术和术后放疗的受试者入组。分析ORN与下颌骨测量值和患者变量的相关性,并建立列线图。 结果: 8.98% 例患者中有 15 例 (167) 在随访期间发生ORN,ORN与糖尿病 (DM) 、体重指数 (BMI) 、剩余骨高度、剩余骨高度与原始骨高度比、切除骨高度与原始骨高度比、下颌剂量 (P:<0.001,分别为 0.004,0.042,0.018,0.010,0.020)。有趣的是,适形和调强放射治疗的ORN风险无显著差异 (P = 0.407)。多因素分析显示,DM和切除骨高度 ≥ 50% 是术后ORN的独立危险因素。建立了BMI、DM、切除骨高度与原始骨高度比、下颌骨切开术和下颌剂量预测无角概率的列线图; ORN状态列线图的c指数为 0.803。 结论: 根据危险因素绘制列线图,加强了对ORN的定量预测。对于ORN概率较高的患者的治疗方案,外科医生应该更加离散。 证据级别: 3b喉镜,130:101-107,2020。

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影响因子:0.73
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颌部疾病方向

颌部的疾病,包括颌畸形、颌骨囊肿、颌骨肿瘤等疾病。

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