Risk factor assessment for the development of osteoradionecrosis
Risk factor assessment for the development of osteoradionecrosis
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DOI：
10.1016/j.joms.2007.05.021
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发表时间：
2007-11-01
影响因子：
1.9
通讯作者：
August, Mereditb
中科院分区：
文献类型：
--
作者：
Goldwaser, Batya R.;Cbuang, Sung-Kiang;August, Mereditb
目的：颌骨放射性骨坏死(ORN)已被广泛研究。然而，关于其病因、危险因素和潜在的疾病机制仍存在争议。这项研究的目的是确定和评估ORN发生的重要危险因素。患者和方法：这是一项对1984年至2005年间马萨诸塞州综合医院82名接受放射治疗的头颈癌患者进行的回顾性队列研究。回顾患者记录以收集人口统计、信息、医疗和牙科病史(包括牙齿干预或创伤)、肿瘤特定数据、治疗细节和随访。具有潜在意义的生物学变量(即年龄和性别)也被评估。主要结果变量是ORN的发展或缺乏ORN的发展。从放疗到ORN的时间，或对于非ORN患者，最后一次随访的时间。访问，是经过计算的。单变量分析确定了与ORN相关的候选变量(P<；15)。使用COX比例风险回归来评估这些候选变量以及与生物学相关的变量。结果：多因素回归发现以下变量与ORN风险降低显著相关：较高的体重指数(P=.02)和类固醇的使用(P=.02)。放射剂量大于66格雷(P=0.03)与ORN风险增加相关。结论：优化营养状况、使用类固醇和限制总辐射剂量可将ORN的风险降至最低。(C)2007年美国口腔和颌面外科医生协会。
Purpose: Osteoradionecrosis (ORN) of the jaws has been extensively studied. However, controversy still exists regarding its etiology, risk factors, and the underlying mechanism of disease. The purpose of this study was to identify and evaluate significant risk factors for the development of ORN.Patients and Methods: This was a retrospective cohort study of 82 Massachusetts General Hospital patients radiated for head and neck cancer between 1984 and 2005. Patient records were reviewed to collect demographic, information, medical and dental history (including dental intervention or trauma), tumor specific data, treatment details, and follow-up. Biologic variables (ie, age and gender) of potential significance were also evaluated. The major outcome variable was the development of ORN or lack of development of ORN. The time from radiation to ORN, or for non-ORN patients, time to last follow-up. visit, was computed. Univariate analyses identified candidate variables associated with ORN (P < .15). Cox proportional hazards regression was used to evaluate these candidate variables as well as biologically relevant variables. Significant prognostic factors for the development of ORN (P < .05) were identified.Results: Multivariate regression identified the following variables as significantly associated with decreased ORN risk: higher body mass index (P = .02) and use of steroids (P = .02). Radiation dose greater than 66 Gray (P = .03) was associated with an increased ORN risk.Conclusions: Optimization of nutritional status, use of steroids, and limitation of total radiation dose may minimize the risk of ORN. (c) 2007 American Association of Oral and Maxillofacial Surgeons.