Pretreatment Systemic Immune-Inflammation Index Predict Needs for Teeth Extractions for Locally Advanced Head and Neck Cancer Patients Undergoing Concurrent Chemoradiotherapy

Abstract

Busra Yilmaz,1 Efsun Somay,2 Ugur Selek,3,4 Erkan Topkan5 1Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Baskent University, Ankara, Turkey; 2Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, Ankara, Turkey; 3Department of Radiation Oncology, School of Medicine, Koc University, Istanbul, Turkey; 4Department of Radiation Oncology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA; 5Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana, TurkeyCorrespondence: Erkan TopkanDepartment of Radiation Oncology, Baskent University Medical Faculty, Adana, 01120, TurkeyTel [phone]Fax [phone]Email [email protected]: To evaluate the utility of pretreatment systemic immune-inflammation index (SII) in predicting the teeth caries and need for tooth extraction after concurrent chemoradiotherapy (C-CRT) for locally advanced squamous-cell head and neck cancer (LA-SCHNC) patients.Methods: The records of LA-SCHNC patients who underwent formal dental evaluations at pre- and post-C-CRT periods were retrospectively analyzed. The pretreatment SII values were calculated using the platelet, neutrophil, and lymphocyte measures acquired on the first day of C-CRT: SII=Platelets×neutrophils/lymphocytes. Receiver operating characteristic (ROC) curve analysis was employed to identify the ideal pre-C-CRT SII cutoff that may predict the teeth caries and the need for tooth extraction after the C-CRT. The primary endpoint was the link between the pre-C-CRT SII and the need for tooth extraction during the follow-up period.Results: A sum of 126 patients were included. Median follow-up was 4.9 years (range: 2.7– 7.8). Nasopharyngeal and laryngeal cancers comprised the majority (75.4%) study cohort. Post-treatment teeth extractions were reported in 62.7% patients. The optimal cutoff was 558 [Area under the curve (AUC): %76.8 sensitivity: 72.3%; and specificity: 70.9%] that grouped the patients into two subgroups with significantly different post-C-CRT tooth extraction rates: Group 1: SII≤ 558 (n = 70) and SII> 558 (n = 56), respectively. Correlation analysis revealed a significant relationship between the pretreatment SII and the tooth extraction rates after the C-CRT (rs:0.89: P = 0.001). The comparative analysis displayed that the teeth extractions rates were significantly higher in the SII> 558 group (77.1% versus 51.4% for SII≤ 558; Hazard ratio: 1.68; P = 0.001). Further analyses showed that the pre-C-CRT SII> 558 was the unique factor associated with meaningfully higher necessities for post-C-CRT teeth extractions.Conclusion: The present outcomes intimated that high pretreatment SII levels were linked to significantly increased post-treatment teeth extractions in LA-SCHNC patients undergoing definitive C-CRT.Keywords: concurrent chemoradiotherapy, head and neck cancers, systemic immune-inflammation index, tooth extraction

Keywords

• concurrent chemoradiotherapy
• head and neck cancers
• systemic immune-inflammation index
• tooth extraction