牙源性颌骨囊肿术后复发的影响因素分析及风险预测研究OA

Objective:To investigate the influencing factors for postoperative recurrence of odontogenic jaw cysts and to construct a risk prediction model.Methods:Clinical data of 461 patients with odontogenic jaw cysts who underwent surgi-cal treatment in our hospital from January 2023 to December 2024 were retrospectively collected.The patients were randomly divided into a training set(n=323)and a validation set(n=138)at a ratio of 7∶3.Patients in the training set were divided into recurrence group and non-recurrence group based on the recurrence status at 1 year postoperatively,and clinical data were collected and compared between the two groups.Univariate analysis and multivariate Logistic regression analysis were used to screen independent influencing factors for recurrence,and a nomogram risk prediction model was constructed accord-ingly.The receiver operating characteristic(ROC)curve was used to evaluate the discrimination of the model,and the area under the curve(AUC),sensitivity,and specificity were calculated.Calibration curve and Hosmer-Lemeshow test were used to evaluate the calibration of the model.Results:The 1-year postoperative recurrence rate of odontogenic jaw cysts was 18.22%(84/461).Multivariate Logistic regression analysis showed that keratocyst[odds ratio(OR)=1.898,95%confidence interval(95%CI)1.329～2.712],cyst diameter(OR=1.697,95%CI 1.142～2.522),simple curettage(OR=1.795,95%CI 1.237～2.605),and neutrophil-to-lymphocyte ratio(NLR)(OR=1.626,95%CI 1.151～2.296)were independent risk fac-tors for postoperative recurrence of odontogenic jaw cysts(P<0.05),while extraction of involved teeth(OR=0.572,95%CI 0.381～0.860)and adjuvant therapy(OR=0.621,95%CI 0.452～0.853)were independent protective factors(P<0.05).A risk prediction model for postoperative recurrence of odontogenic jaw cysts was constructed based on the results of multivariate Logistic regression analysis.The risk scores corresponding to keratocyst,cyst diameter,simple curettage,extraction of involved teeth,adjuvant therapy,and NLR factors were 91 points,82 points,79 points,65 points,85 points,and 83 points,respectively.The AUC of the model for predicting postoperative recurrence in the training set was 0.965(95%CI 0.939～0.982),with a sensitivity of 95.24%and a specificity of 85.38%,the AUC for predicting postoperative recurrence in the validation set was 0.937(95%CI 0.882～0.971),with a sensitivity of 90.48%and a specificity of 89.74%.The predicted probabilities of re-currence in both the training set and the validation set were close to the ideal curve.The Hosmer-Lemeshow test showed χ2=4.126,P=0.127 for the training set and χ2=2.851,P=0.094 for the validation set.Conclusion:Keratocyst,cyst diameter,simple curettage,and NLR are independent risk factors for postoperative recurrence of odontogenic jaw cysts,while extraction of involved teeth and adjuvant therapy are independent protective factors.The nomogram prediction model constructed based on the above factors demonstrates good predictive performance,which is helpful for identifying high-risk patients and guiding individualized treatment.