Global Immune-Nutrition-Inflammation Index as a novel comprehensive biomarker in predicting the radiation-induced trismus rates in locally advanced nasopharyngeal carcinoma patients

Nasopharyngeal carcinoma (NPC) is a prevalent cancer in certain regions, often treated with concurrent chemoradiotherapy (CCRT), which can lead to complications such as radiation-induced trismus (RIT). In this study, we aimed to evaluate whether the novel pretreatment Global Immune-Nutrition-Inflammation Index (GINI) can predict RIT in locally advanced nasopharyngeal carcinoma (LA-NPC) patients undergoing CCRT. Data of LA-NPC patients presenting without RIT were reviewed retrospectively. Any post-CCRT maximum mouth openings (MMO) <= 35 mm were considered RIT. The GINI index was calculated using the formula: GINI = (CRP x Monocytes x Platelets x Neutrophils) divided by (Albumin x Lymphocytes). We used receiver operating characteristic (ROC) curve analysis to examine the potential correlation between pretreatment GINI measures and post-CCRT RIT status. Logistic regression analysis examined the independence of the association between confounding factors and RIT rates. The study comprised 230 participants, and 52 (22.6%) received an RIT diagnosis. The optimal pre-CCRT GINI cutoff that dichotomizes RIT rates was determined to be 1424 (area under the curve [AUC]: 76%; sensitivity: 75.0%; specificity: 71.7%; J-index: 0.463). RIT incidence was significantly higher in the GINI >= 1424 group than in its GINI < 1424 counterpart (43.3% vs 9.3%; Hazard ratio (HR): 4.76; P < 0.001). Multivariate logistic regression analysis revealed that a pre-CCRT GINI >= 1424 was an independent predictor of increased RIT rates after definitive CCRT in this patient group (P < 0.001). In conclusion, the present results revealed that elevated pre-CCRT GINI measures (>= 1424) can efficiently and independently predict elevated RIT rates in LA-NPC patients after CCRT.