Giudice Amerigo, Barone Selene, Diodati Federica, Antonelli Alessandro, Nocini Riccardo, Cristofaro Maria Giulia
Associate Professor, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy.
Resident, School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy.
J Oral Maxillofac Surg. 2020 Nov;78(11):1986-1999. doi: 10.1016/j.joms.2020.05.037. Epub 2020 Jun 1.
There is no clarity on which protocol is proper to use in the management of medication-related osteonecrosis of the jaw (MRONJ) at early stages (ie, stages 1 and 2) to halt disease progression. The aim of this study was to evaluate the success of surgical treatment in terms of time to mucosal integrity and downstaging in patients with MRONJ at early stages.
The study was implemented as a prospective, single-center cohort study. The sample included patients who presented at Magna Graecia University of Catanzaro with a clinical diagnosis of MRONJ and underwent surgical treatment. The primary predictor variables were gender, age, medical history, drug administration, MRONJ localization, trigger factors, and stage. The outcome variables were 1) time to mucosal integrity after surgery with time-to-event analysis and 2) time to downstaging of MRONJ lesions. Descriptive, bivariate, and regression statistics were performed.
The study sample included 129 MRONJ patients (90 women and 39 men; mean age, 71.2 ± 12.7 years), of whom 57 had stage 1 and 72 had stage 2. The mean time to achieve mucosal integrity was 71.6 ± 67.7 days, considering the survival probability always to be 93% or greater. The mean time to achieve downstaging of the lesion was 43.6 ± 38.4 days. Patients older than 70 years, those affected by osteometabolic disorders, and those treated with oral antiresorptive therapy showed a significantly shorter time to mucosal healing and downstaging (P < .05). In patients with stage 2 MRONJ, we recorded a significantly longer time to mucosal integrity (56.4 ± 54.5 days) but shorter time to lesion downstaging (33.6 ± 9.9 days) than in patients with stage 1 MRONJ (P < .05).
Surgical treatment of patients in the early stages of MRONJ guarantees benefits in outcomes such as mucosal integrity and lesion downstaging, improvement in quality of life, and faster reuptake of medication therapy, especially for oncologic patients.
在颌骨药物相关性骨坏死（MRONJ）早期阶段（即1期和2期），对于采用何种恰当方案来阻止疾病进展尚无定论。本研究的目的是评估早期MRONJ患者手术治疗在实现黏膜完整性的时间以及病情降期方面的成功率。
本研究为前瞻性、单中心队列研究。样本包括在卡坦扎罗大希腊大学临床诊断为MRONJ并接受手术治疗的患者。主要预测变量包括性别、年龄、病史、药物使用情况、MRONJ的部位、触发因素和分期。结局变量为：1）采用事件发生时间分析术后达到黏膜完整性的时间；2）MRONJ病变降期的时间。进行了描述性、双变量和回归统计分析。
研究样本包括129例MRONJ患者（90例女性和39例男性；平均年龄71.2±12.7岁），其中57例为1期，72例为二期。考虑到生存概率始终≥93%，实现黏膜完整性的平均时间为71.6±67.7天。病变降期的平均时间为43.6±38.4天。年龄大于70岁、患有骨代谢疾病以及接受口服抗吸收治疗的患者，黏膜愈合和病变降期的时间显著缩短（P<0.05）。在2期MRONJ患者中，我们记录到达到黏膜完整性的时间显著更长（56.4±54.5天），但病变降期的时间比1期MRONJ患者更短（33.6±9.9天）（P<0.05）。
MRONJ早期患者的手术治疗可保证在黏膜完整性和病变降期、生活质量改善以及药物治疗更快恢复等结局方面取得益处，尤其是对于肿瘤患者。
