Predicting osteoradionecrosis in nasopharyngeal carcinoma: The role of the GLUCAR index.

Authors

Efsun Somay, Erkan Topkan, Sibel Bascil, Sukran Senyurek, Duriye Ozturk, Nilufer Kılıc Durankuş, Ugur Selek

Published in

Dental and medical problems. Volume 63. Issue 5. Pages 1199-1208.

Abstract

Osteoradionecrosis (ORN) is a debilitating complication of concurrent chemoradiotherapy (CCRT) in patients with locally advanced nasopharyngeal carcinoma (LANPC). The early identification of patients at risk is crucial.
The aim of the present study was to evaluate the predictive value of the GLUCAR index, which integrates fasting glucose and the C-reactive protein (CRP)-to-albumin ratio (CAR), for assessing the risk of ORN in patients with LANPC undergoing CCRT.
A retrospective analysis was conducted in a consecutive cohort of 220 patients with LANPC who underwent definitive CCRT. The patients were stratified into highand low-GLUCAR groups according to their pre-treatment GLUCAR index levels, using the optimal cut-off value determined by the receiver operating characteristic (ROC) curve analysis. Osteoradionecrosis was defined as the event of interest. Multivariate Cox proportional hazards regression analysis was performed to identify independent predictors of ORN development.
The overall incidence of ORN was 10.9%. The optimal cut-off value of the GLUCAR index for predicting ORN was 35.7 (area under the curve (AUC): 0.773; sensitivity: 75.0%, and specificity: 76.5%). Patients with a GLUCAR index ≥35.7 had a significantly higher incidence of ORN than those with a GLUCAR index <35.7 (27.3% vs. 3.9%; p < 0.001). The multivariate analysis identified a GLUCAR index ≥35.7 as an independent predictor of ORN development (odds ratio (OR): 9.09; 95% confidence interval (CI): 2.48-25.02; p < 0.001). Other independent predictors included smoking, pre-CCRT tooth extractions, a higher number of chemotherapy cycles, and a higher mandibular radiation dose (p < 0.05 for all).
The results of this study suggest that a pre-treatment GLUCAR index ≥35.7 is independently associated with an increased risk of ORN in patients with LANPC undergoing definitive CCRT.

PMID:
43006296
Bibliographic data and abstract were imported from PubMed on 10 Nov 2026.

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