Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Bei-hu Branch, Taipei, Taiwan.
Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan; Department of Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.
J Formos Med Assoc. 2021 Aug;120(8):1572-1580. doi: 10.1016/j.jfma.2020.11.017. Epub 2020 Dec 11.
BACKGROUND/PURPOSE: Anti-resorptive agents are commonly used in cancer patients with bone metastasis or multiple myeloma (MM). An adverse event termed medication-related osteonecrosis of the jaws (MRONJ) was discovered in patients using these agents but relatively little attention has been paid to its prognosis. Our aims were to find out the treatment outcomes and prognostic indicators of MRONJ in cancer patients who received zoledronic acid as antiresorptive therapy.
We retrospectively surveyed a cohort of 133 cancer patients who received zoledronic acid. A total of 150 MRONJ lesions were included for investigation. Cumulative complete response rate after treatment was calculated with the Kaplan-Meier method, and significance was examined with the log-rank tests. Cox regression was used for univariate and multivariate analyses of prognostic factors.
The cumulative complete response rate of all patients at 24 months was 53.2%, and those of patients with MM, breast cancer and prostate cancer were 27.8%, 60.7% and 68.0%, respectively. Having MM was identified as an independent prognostic factor in a multivariate analysis with adjusted hazard ratios of 0.28 (95% confidence interval, 0.09-0.83).
For cancer patients with ONJ related to zoledronic acid, patients with MM endure a worse treatment outcome.
背景/目的：抗吸收剂常用于有骨转移或多发性骨髓瘤（MM）的癌症患者。在使用这些药物的患者中发现了一种称为药物相关性颌骨坏死（MRONJ）的不良事件，但对其预后关注甚少。我们的目的是找出接受唑来膦酸作为抗吸收治疗的癌症患者中 MRONJ 的治疗结果和预后指标。
我们回顾性调查了接受唑来膦酸治疗的 133 例癌症患者队列。共纳入了 150 例 MRONJ 病变进行研究。采用 Kaplan-Meier 法计算治疗后完全缓解的累积率，并采用对数秩检验进行显著性检验。Cox 回归用于预后因素的单因素和多因素分析。
所有患者在 24 个月时的完全缓解累积率为 53.2%，MM、乳腺癌和前列腺癌患者的完全缓解累积率分别为 27.8%、60.7%和 68.0%。在多因素分析中，MM 被确定为独立的预后因素，调整后的危险比为 0.28（95%置信区间，0.09-0.83）。
对于与唑来膦酸相关的 ONJ 的癌症患者，MM 患者的治疗结果更差。
