Departments of1Neurological Surgery and.
2Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon.
J Neurosurg Spine. 2023 Sep 1;39(6):722-728. doi: 10.3171/2023.4.SPINE22584. Print 2023 Dec 1.
Bone morphogenetic protein (BMP) has been increasingly used in spinal surgery to promote arthrodesis. Because BMP stimulates cellular proliferation, its association with tumorigenesis is a concern. Previous research has generated conflicting conclusions on the risk of cancer in patients receiving BMP. The authors aimed to compare the incidence of solid organ and hematopoietic malignancies in patients undergoing spinal arthrodesis with or without BMP.
The PearlDiver Mariner Patient Claims Database was queried for patients undergoing thoracolumbar fusion between 2015 and 2021. Patients with preexisting malignancy were excluded. Data were analyzed for incidence of solid organ malignancy and hematopoietic malignancy diagnosed after spinal surgery. Propensity score matching using age, sex, tobacco usage, and year of surgery was performed between patients who did and those who did not receive BMP.
Among patients without prior solid organ malignancy, BMP was used in 22,139 patients and not used in 306,249. In the propensity score-matched group, 3.1% of the BMP group developed solid organ malignancy following surgery compared with 3.5% in the non-BMP group. The relative risk (RR) of developing solid organ malignancy after BMP exposure was 0.89 (95% CI 0.81-0.98, p = 0.02). Among patients without prior hematopoietic malignancy, BMP was used in 23,505 patients and not used in 328,796 patients. In the propensity score-matched group, 0.4% of the BMP group developed hematopoietic malignancy compared with 0.6% of the non-BMP group. The RR of developing hematopoietic malignancy after BMP exposure was 0.71 (95% CI 0.55-0.93, p = 0.015).
BMP use in thoracolumbar fusion was not associated with an increased risk of new malignancy, which further supports emerging data on the lack of an association between BMP use and increased malignancy.
骨形态发生蛋白（BMP）在脊柱外科中越来越多地用于促进关节融合。由于 BMP 刺激细胞增殖，其与肿瘤发生的关系令人担忧。先前的研究对接受 BMP 治疗的患者发生癌症的风险得出了相互矛盾的结论。作者旨在比较接受或不接受 BMP 的脊柱关节融合患者实体器官和血液恶性肿瘤的发病率。
通过 PearlDiverMariner 患者索赔数据库查询 2015 年至 2021 年间接受胸腰椎融合的患者。排除有预先存在恶性肿瘤的患者。分析脊柱手术后诊断出的实体器官恶性肿瘤和血液恶性肿瘤的发病率。在接受 BMP 治疗和未接受 BMP 治疗的患者之间，使用年龄、性别、吸烟状况和手术年份进行倾向评分匹配。
在没有先前实体器官恶性肿瘤的患者中，有 22139 名患者使用了 BMP，306249 名患者未使用 BMP。在倾向评分匹配组中，BMP 组术后发生实体器官恶性肿瘤的比例为 3.1%，而非 BMP 组为 3.5%。BMP 暴露后发生实体器官恶性肿瘤的相对风险（RR）为 0.89（95%CI0.81-0.98，p=0.02）。在没有先前血液恶性肿瘤的患者中，有 23505 名患者使用了 BMP，328796 名患者未使用 BMP。在倾向评分匹配组中，BMP 组发生血液恶性肿瘤的比例为 0.4%，而非 BMP 组为 0.6%。BMP 暴露后发生血液恶性肿瘤的 RR 为 0.71（95%CI0.55-0.93，p=0.015）。
胸腰椎融合中使用 BMP 与新发恶性肿瘤的风险增加无关，这进一步支持了 BMP 使用与恶性肿瘤风险增加之间缺乏关联的新兴数据。
