Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taiwan.
Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taiwan; Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan.
Radiother Oncol. 2017 Jun;123(3):406-411. doi: 10.1016/j.radonc.2017.05.001. Epub 2017 May 19.
To identify the risk factors for osteonecrosis of the jaw (ONJ) in oral cancer patients after surgery with and without adjuvant therapy in a nationwide, population-based study.
Using the Taiwan National Health Insurance Research Dataset, we recruited patients with newly diagnosed oral cancer between 1997 and 2011. All of them underwent primary surgery. Data regarding demographic characteristics; tooth extractions; medications; and cancer treatments, including types of mandibular surgery, radiotherapy and platinum-based chemotherapy, were collected for analysis.
We identified 25,858 patients who suffered 2802 ONJ events. The ONJ incidence rate was 3.45 per 100 person-years. Lip cancer was associated with the highest risk of ONJ, followed by buccal mucosa, gum, mouth floor and tongue cancer. Using a time-dependent Cox regression model, multivariable analysis demonstrated that mandibulotomy (hazard ratio (HR), 1.25; 95% confidence interval (CI), 1.01-1.55; p<0.001), radiotherapy (HR, 1.39; 95% CI, 1.26-1.54; p<0.001) and platinum-based chemotherapy (HR, 1.94; 95% CI, 1.56-2.41; p<0.001) were significant risk factors for ONJ. In the subgroup analysis of patients receiving radiotherapy and patients not receiving radiotherapy, platinum-based chemotherapy remained a risk factor for ONJ.
Mandibulotomy, radiotherapy and platinum-based chemotherapy were associated with an increased ONJ risk. Chemotherapy was a risk factor regardless of whether radiotherapy was administered.
本项全国性基于人群的研究旨在确定口腔癌患者在接受手术及辅助治疗后发生颌骨坏死（ONJ）的风险因素。
利用台湾全民健康保险研究数据库，我们招募了 1997 年至 2011 年间新诊断为口腔癌的患者。所有患者均接受了初次手术。收集了人口统计学特征、拔牙、药物以及癌症治疗（包括下颌骨手术类型、放疗和铂类化疗）相关数据进行分析。
我们共确定了 25858 例患者，其中 2802 例患者发生了 ONJ 事件。ONJ 的发生率为每 100 人年 3.45 例。唇癌患者的 ONJ 风险最高，其次为颊黏膜、牙龈、口底和舌癌患者。采用时依 Cox 回归模型进行多变量分析，结果表明下颌骨切开术（危险比（HR），1.25；95%置信区间（CI），1.01-1.55；p<0.001）、放疗（HR，1.39；95%CI，1.26-1.54；p<0.001）和铂类化疗（HR，1.94；95%CI，1.56-2.41；p<0.001）是 ONJ 的显著风险因素。在接受放疗和未接受放疗的患者亚组分析中，铂类化疗仍然是 ONJ 的风险因素。
下颌骨切开术、放疗和铂类化疗与 ONJ 风险增加相关。是否接受放疗，化疗都是 ONJ 的风险因素。
