AccScience Publishing / ARNM / Online First / DOI: 10.36922/arnm.5799
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ORIGINAL RESEARCH ARTICLE

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

Efsun Somay1* ,  Erkan Topkan2 ,  Sükran Senyürek3 ,  Nilüfer Kılıç Durankuş3 ,  Düriye Öztürk4 ,  Ugur Selek3
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1 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, Ankara, Turkey
2 Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana, Turkey
3 Department of Radiation Oncology, School of Medicine, Koc University, Istanbul, Turkey
4 Department of Radiation Oncology, School of Medicine, Afyonkarahisar Health and Science University, Afyonkarahisar, Turkey
ARNM, 5799 https://doi.org/10.36922/arnm.5799
Submitted: 6 November 2024 | Revised: 20 November 2024 | Accepted: 20 December 2024 | Published: 17 January 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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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
Funding
None.
Conflict of interest
The authors declare that they have no competing interests.
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