Clinical Lecturer, University of Manchester Division of Dentistry, School of Medical Sciences, Oral Surgery Department, Manchester, UK; Clinical Teacher, King's College Hospital, Oral Surgery Department, London, UK.
Foundation Training Dentist, Kings College Hospital, Oral Surgery Department, London, UK.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2021 Jun;131(6):650-659. doi: 10.1016/j.oooo.2021.01.001. Epub 2021 Jan 8.
Osteonecrosis of the jaw (ONJ) is reported to be primarily associated with patients receiving bisphosphonate therapies but has been found in patients taking a number of other medications. A number of recent reports have noted the presence of metastatic cancers in the histologic analysis of osteonecrotic lesions from the jaw. The aim of the present review is to estimate the frequency and the type of metastatic cancer most commonly found in ONJ specimens in patients undergoing antiresorptive and/or antiangiogenic drug therapy.
A multidatabase (PubMed, MEDLINE, EMBASE, and CINAHL) systematic search was performed. Any studies involving human participants treated with antiresorptive and antiangiogenic drugs were considered. Where study patients presented with malignant cells within osteonecrotic specimens, further data were collected. Data are presented using descriptive statistics.
A total of 13 studies met the inclusion criteria for this systematic review. Thirty-seven study patients had histologic evidence of malignant cells within medication-related osteonecrosis of the jaw (MRONJ) specimens. The most frequent phenotype of malignant cells found within MRONJ specimens were breast cancer variants (n = 15). The frequency of malignant tumor cells found within the MRONJ specimens was calculated using 4 studies. Out of 604 patients, the frequency was 4.64% (n = 28).
Based on the limited data available in the literature, it is plausible that not histologically analyzing all ONJ specimens could result in a small number of undiagnosed and untreated malignant diseases. Additional data based on a larger cohort of study patients is necessary to understand the role of MRONJ in metastatic spread and the influence of surgical treatment and reoccurrence.
颌骨骨坏死（ONJ）主要与接受双膦酸盐治疗的患者相关，但也有许多患者在服用其他药物时发生。最近有许多报道指出，在接受抗吸收和/或抗血管生成药物治疗的患者的颌骨骨坏死病变的组织学分析中存在转移性癌症。本综述的目的是估计在接受抗吸收和抗血管生成药物治疗的患者的 ONJ 标本中最常见的转移性癌症的频率和类型。
进行了多数据库（PubMed、MEDLINE、EMBASE 和 CINAHL）系统检索。考虑了涉及接受抗吸收和抗血管生成药物治疗的人类参与者的任何研究。如果研究患者的骨坏死标本中存在恶性细胞，则进一步收集数据。数据使用描述性统计进行呈现。
共有 13 项研究符合本系统综述的纳入标准。37 名研究患者的颌骨药物相关性骨坏死（MRONJ）标本中有组织学证据表明存在恶性细胞。在 MRONJ 标本中发现的恶性细胞最常见的表型是乳腺癌变异体（n=15）。使用 4 项研究计算了 MRONJ 标本中恶性肿瘤细胞的频率。在 604 名患者中，频率为 4.64%（n=28）。
根据文献中有限的数据，不分析所有 ONJ 标本可能会导致少数未诊断和未经治疗的恶性疾病漏诊。需要基于更大的研究患者队列的数据来了解 MRONJ 在转移扩散中的作用以及手术治疗和复发的影响。
