Abstract:Objectives The purpose of this study was to explore prognostic factors associated with the occurrence of skull base osteoradionecrosis (sbORN) in patients with nasopharyngeal cancer (NPC) and analyze potential factors influencing patient survival. Methods A retrospective cohort study was conducted using clinical data of NPC patients with sbORN admitted to Meizhou People's Hospital from January 1, 2001, to July 31, 2023. The patients were divided into deceased and surviving groups based on their survival status, and differences between the groups were compared using t-tests and Fisher's exact tests. Survival analysis was performed using Kaplan-Meier survival curves and Cox proportional hazards models to assess the impact of different prognostic factors on patient survival.Results A total of 31 patients were included, with 23 males and 8 females. Among them, 16 patients died, with the leading causes being massive bleeding (6 cases, 37.5%), septicemia (7 cases, 43.75%), multiple organ failure (2 cases, 12.5%), and brainstem infarction (1 case, 6.25%). The median survival time was 23 months, with a 1-year survival rate of 70.96% (22/31) and a 2-year survival rate of 54.83% (17/31). Serum parathyroid hormone (PTH) level reached a significant level concerning the occurrence of sbORN (χ2 = 4.229, P = 0.040), indicating a relationship between PTH and sbORN. In terms of lesion extent, patients with lesions involving the intracranial region had a significantly higher incidence of die compared to those with non-intracranial lesions (χ2 = 7.515, P = 0.006). After dividing patients into deceased and surviving groups, lower BMI, lower hemoglobin levels, and higher pre-albumin levels were found to be associated with poorer prognosis (all P-values < 0.05). Cox regression multivariate analysis revealed that intracranial involvement of necrosis (HR=0.206,95%CI:0.066~0.637,P=0.006)) and elevated PTH levels (HR=3.311,95%CI:1.120~9.791,P=0.030) were independent risk factors for adverse prognosis. Conclusion sbORN has a serious negative impact on NPC survival rate.During the treatment process of nasopharyngeal carcinoma (NPC) patients with skull base osteoradionecrosis (sbORN), monitoring procalcitonin levels and performing enhanced magnetic resonance imaging of the nasopharynx (to assess intracranial extension of necrosis) are necessary. Early intervention is crucial to prevent infections, improve nutritional status, and ultimately enhance patient survival.