Carlson Eric R, Fleisher Kenneth E, Ruggiero Salvatore L
Professor and Kelly L. Krahwinkel Chair, Department of Oral and Maxillofacial Surgery; Director, Oral and Maxillofacial Surgery Residency Program; Director, Oral/Head and Neck Oncologic Surgery Fellowship Program, University of Tennessee Medical Center and University of Tennessee Cancer Institute, Knoxville, TN.
J Oral Maxillofac Surg. 2013 Dec;71(12):2077-86. doi: 10.1016/j.joms.2013.05.014. Epub 2013 Aug 12.
The aim of the present study was to investigate the microscopic presence of metastatic cancer in jaw specimens clinically and histologically diagnosed as having osteonecrosis in patients receiving intravenous bisphosphonate medications.
A retrospective cohort multicenter study was designed. Patients from the University of Tennessee Medical Center, New York University Medical Center, and New York Center for Orthognathic and Maxillofacial Surgery were enrolled who had been treated with intravenous bisphosphonate medications for an underlying diagnosis of cancer and who had been clinically diagnosed with bisphosphonate-related osteonecrosis of the jaws (BRONJ). The institutional review boards approved the present study. The primary predictor variable was the clinical presence of BRONJ. The primary outcome variable was the microscopic presence of metastatic cancer in the osteonecrotic jaw specimens.
A total of 744 sites of BRONJ were clinically diagnosed. Of these sites, 552 (74%) were diagnosed in patients who had received intravenous bisphosphonate medications. Of these 552 sites, 357 (65%) underwent microscopic evaluation through biopsy, sequestrectomy, or resection with curative intent. Of the 357 sites of BRONJ subjected to microscopic analysis, 19 (5.3%) sites were diagnosed with 20 cancers in 16 patients.
Albeit rare, the presence of cancer in a BRONJ specimen represents 1 explanation for the development of osteonecrosis in patients exposed to intravenous bisphosphonate medications in whom a clinical diagnosis of BRONJ has been applied. Additional molecular information is needed to provide an explanation for this observation.
本研究旨在调查在接受静脉注射双膦酸盐药物治疗且临床和组织学诊断为骨坏死的颌骨标本中转移性癌的微观存在情况。
设计了一项回顾性队列多中心研究。纳入田纳西大学医学中心、纽约大学医学中心以及纽约正颌与颌面外科中心的患者，这些患者因潜在癌症诊断接受了静脉注射双膦酸盐药物治疗，且临床诊断为双膦酸盐相关颌骨骨坏死（BRONJ）。各机构审查委员会批准了本研究。主要预测变量为BRONJ的临床存在情况。主要结局变量为骨坏死颌骨标本中转移性癌的微观存在情况。
临床共诊断出744处BRONJ。其中，552处（74%）诊断于接受静脉注射双膦酸盐药物治疗的患者。在这552处中，357处（65%）通过活检、死骨切除术或根治性切除进行了微观评估。在接受微观分析的357处BRONJ中，19处（5.3%）在16例患者中诊断出20处癌症。
尽管罕见，但BRONJ标本中存在癌症是接受静脉注射双膦酸盐药物治疗且临床诊断为BRONJ的患者发生骨坏死的一种解释。需要更多分子信息来解释这一观察结果。
