乳腺癌术后唑来膦酸/地诺单抗相关颌骨坏死风险预测模型的构建与验证OA

Objective:To identify high-risk factors for medication-related osteonecrosis of the jaw(MRONJ)in postoper-ative breast cancer patients treated with anti-resorptive agents(zoledronic acid/denosumab),and to construct and validate a risk prediction model.Methods:We retrospectively enrolled 135 patients who visited the Department of Stomatology at Chengdu Sixth People's Hospital and West China Hospital of Stomatology,Sichuan University between June 2020 and June 2025.All patients had previously undergone radical mastecto-my for breast cancer and received adjuvant anti-bone metastasis therapy with zoledronic acid or denosumab.They were ran-domly assigned to training and validation sets at a ratio of 7:3.Lasso regression was employed to screen predictors of MRONJ.Predictive performance was assessed using the C-index,area under the curve(AUC),calibration curves,risk score plots,and stratified validation.Finally,a nomogram was constructed.Results:The Lasso regression model identified invasive oral procedures,glucocorticoid use,history of menopause,duration of medication use and combined radiotherapy as significant predictors of MRONJ in patients receiving anti-resorptive agents(zoledronic acid/denosumab).Time-dependent ROC curves at 3 and 5 years were plotted in both the training and validation sets.The AUC values were 0.81(3-year)and 0.79(5-year)in the training set,and 0.78(3-year)and 0.79(5-year)in the validation set.The predicted probabilities of MRONJ at 3 and 5 years showed good agreement with the actual probabilities in both the training and validation sets.Risk score plots and stratified re-validation demonstrated that the five predictors had good predictive performance.Conclusion:The predictive nomogram developed in this study can effectively predict the risk of MRONJ in postoperative breast cancer pa-tients receiving anti-resorptive agents(zoledronic acid/denosumab).