National Clinical Research Center for Oral Disease, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, 200011, China.
Biomed Res Int. 2020 Oct 15;2020:5847429. doi: 10.1155/2020/5847429. eCollection 2020.
Patients with stage 3 medication-related osteonecrosis of the jaw (MRONJ) suffer from severe complications. Chemotherapeutic agents and targeted drugs are considered to be associated with the development of MRONJ. However, little is known regarding the association of those agents with stage 3 MRONJ. The purpose of this study is to analyze the comprehensive medication history of patients with advanced-stage MRONJ (stage 2 and stage 3) and evaluate the possible risk factors for stage 3 MRONJ. . Sixty patients with advanced-stage MRONJ were involved in this retrospective study. Patients with developmental maxillofacial anomalies, previous radiation in the head and neck areas, and jaw bone tumors were excluded from the study. All patients were divided into two groups by their MRONJ stage (stage 2 or stage 3). Demographic and clinical characteristics, comprehensive medication data (bisphosphonates, chemotherapeutic agents, targeted drugs, and immunosuppressive agents), and results of serological biomarkers were recorded and compared between two groups. Univariate and multivariate logistic regressions were performed by SPSS 25.0 for evaluating risk factors of stage 3 MRONJ.
Our results indicate that chemotherapy (adjusted OR = 3.43; 95% CI: 1.03 to 11.38), targeted drugs (adjusted OR = 3.69; 95% CI: 1.06 to 12.80), and maxillary lesions (adjusted OR = 4.26; 95% CI: 1.19 to 15.23) increase the risk of stage 3 MRONJ.
The outcome of this study justifies that chemotherapeutic agents and targeted drugs are probably risk factors for stage 3 MRONJ. In addition, the osteonecrosis in maxilla is more easily to develop into stage 3 MRONJ. Intense clinical observation is recommended in MRONJ patients with maxillary osteonecrosis and in those who concurrently administered bisphosphonates, chemotherapeutic agents, and/or targeted drugs. This trial is registered with ChiCTR2000032428.
患有 3 期药物相关性颌骨坏死（MRONJ）的患者会遭受严重并发症。化疗药物和靶向药物被认为与 MRONJ 的发生有关。然而，对于这些药物与 3 期 MRONJ 的关系知之甚少。本研究的目的是分析晚期 MRONJ（2 期和 3 期）患者的综合用药史，并评估 3 期 MRONJ 的可能危险因素。
本回顾性研究纳入了 60 例晚期 MRONJ 患者。患有发育性颌面畸形、头颈部既往放疗和颌骨肿瘤的患者被排除在外。所有患者均根据 MRONJ 分期（2 期或 3 期）分为两组。记录并比较两组患者的人口统计学和临床特征、综合用药数据（双膦酸盐、化疗药物、靶向药物和免疫抑制剂）以及血清生物标志物结果。采用 SPSS 25.0 进行单因素和多因素逻辑回归分析，评估 3 期 MRONJ 的危险因素。
本研究结果表明，化疗（调整后 OR = 3.43；95%CI：1.03 至 11.38）、靶向药物（调整后 OR = 3.69；95%CI：1.06 至 12.80）和上颌病变（调整后 OR = 4.26；95%CI：1.19 至 15.23）增加了 3 期 MRONJ 的风险。
本研究结果表明，化疗药物和靶向药物可能是 3 期 MRONJ 的危险因素。此外，上颌骨坏死更容易发展为 3 期 MRONJ。建议对同时接受双膦酸盐、化疗药物和/或靶向药物治疗且伴有上颌骨坏死的 MRONJ 患者进行密切的临床观察。本试验已在中国临床试验注册中心注册，注册号为 ChiCTR2000032428。
