Prognostic risk factors in patients with jaw osteoradionecrosis: A retrospective cohort study at a tertiary teaching hospital

Abstract

Background/Objective

Osteoradionecrosis of the jaws (ORNJ) is a severe complication of radiotherapy for head and neck cancer, with limited data on prognostic factors. This study aimed to identify risk factors associated with wound healing prognosis in ORNJ patients.

Methods

A retrospective cohort study was conducted following STROBE guidelines, including 106 ORNJ patients treated at a tertiary hospital between 2005 and 2020. Patients were divided into normal wound healing (NH, within 7–10 days postoperatively) and delayed wound healing (DH, ≥11 days postoperatively) groups. Univariate analysis, multivariate Logistic regression, and Cox proportional hazards models were used to identify prognostic factors.

Results

The median follow-up was 38.6 months. Univariate analysis showed DH patients had significantly higher baseline PIV (median: 490.1 vs 437.8) and SII (median: 775.6 vs 732.2) than NH patients (all p < 0.001). Multivariate logistic regression showed that diabetes mellitus (OR = 9.687, p = 0.010), Charlson comorbidity index (CCI, OR = 10.004, p < 0.001), primary tumor site (OR = 10.384, p = 0.006), T stage (OR = 27.340, p < 0.001), ORNJ grade at diagnosis (OR = 4.367, p < 0.001), pan-immune-inflammatory value (PIV, OR = 1.043, p < 0.001), and systemic immune-inflammatory index (SII, OR = 1.023, p < 0.001) were independent risk factors for delayed healing. Kaplan-Meier curves showed that patients in the highest PIV tertile had significantly longer time-to-healing (median: 31.5 vs 18.3 days, Log-rank p < 0.001).

Conclusions

PIV and SII, along with clinical factors (diabetes mellitus, CCI, T stage, ORNJ grade), are independent prognostic factors for wound healing in ORNJ patients. These findings may help clinicians optimize treatment strategies and predict outcomes.