一项基于人群的多中心回顾性研究：乳腺癌患者20年随访期间颌骨药物相关性骨坏死的发病率
Incidence of Medication-Related Osteonecrosis of the Jaw in Patients With Breast Cancer During a 20-Year Follow-Up: A Population-Based Multicenter Retrospective Study.
作者信息
Brunner Christine, Arvandi Marjan, Marth Christian, Egle Daniel, Baumgart Florentina, Emmelheinz Miriam, Walch Benjamin, Lercher Johanna, Iannetti Claudia, Wöll Ewald, Pechlaner Agnes, Zabernigg August, Volgger Birgit, Castellan Maria, Andraschofsky Oliver Tibor, Markl Alice, Hubalek Michael, Schnallinger Michael, Puntscher Sibylle, Siebert Uwe, Schönherr Sebastian, Forer Lukas, Bruckmoser Emanuel, Laimer Johannes
机构信息
Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria.
Department of Public Health, Health Services Research and Health Technology Assessment, Medical Decision Making and Health Technology Assessment, Institute of Public Health, UMIT TIROL-University for Health Sciences and Technology, Hall in Tirol, Austria.
出版信息
J Clin Oncol. 2025 Jan 10;43(2):180-188. doi: 10.1200/JCO.24.00171. Epub 2024 Aug 20.
PURPOSE
Medication-related osteonecrosis of the jaw (MRONJ) is one of the most important toxicities of antiresorptive therapy, which is standard practice for patients with breast cancer and bone metastases. However, the population-based incidence of MRONJ is not well established. We therefore performed a retrospective multicenter study to assess the incidence for a whole Austrian federal state (Tyrol).
MATERIALS AND METHODS
This retrospective multicenter study was conducted between 2000 and 2020 at all nine breast centers across Tyrol, Austria. Using the cancer registry, the total Tyrolean population was screened for all patients with breast cancer. All patients with breast cancer and bone metastases receiving antiresorptive therapy were finally included in the study.
RESULTS
From 8,860 patients initially screened, 639 individuals were eligible and included in our study. Patients received antiresorptive therapy once per month without de-escalation of therapy. MRONJ was diagnosed in 56 (8.8%, 95% CI, 6.6 to 11.0) patients. The incidence of MRONJ was 11.6% (95% CI, 8.0 to 15.3) in individuals treated with denosumab only, 2.8% (95% CI, 0.7 to 4.8) in those treated with bisphosphonates only, and 16.3% (95% CI, 8.8 to 23.9) in the group receiving bisphosphonates followed by denosumab. Individuals developed MRONJ significantly earlier when treated with denosumab. Time to MRONJ after treatment initiation was 4.6 years for individuals treated with denosumab only, 5.1 years for individuals treated with bisphosphonates only, and 8.4 years for individuals treated with both consecutively.
CONCLUSION
MRONJ incidence in breast cancer patients with bone metastases was found to be considerably higher, especially for patients receiving denosumab, when compared with available data in the literature. Additionally, patients treated with denosumab developed MRONJ significantly earlier.
目的
颌骨药物相关性骨坏死（MRONJ）是抗骨吸收治疗最重要的毒性反应之一，这是乳腺癌和骨转移患者的标准治疗方法。然而，基于人群的MRONJ发病率尚未明确。因此，我们进行了一项回顾性多中心研究，以评估奥地利整个蒂罗尔州的发病率。
材料与方法
这项回顾性多中心研究于2000年至2020年在奥地利蒂罗尔州的所有9个乳腺中心进行。利用癌症登记处，对蒂罗尔州的全部人口进行筛查，以找出所有乳腺癌患者。最终，所有接受抗骨吸收治疗的乳腺癌和骨转移患者都被纳入研究。
结果
在最初筛查的8860名患者中，有639人符合条件并被纳入我们的研究。患者每月接受一次抗骨吸收治疗，且治疗未降级。56名（8.8%，95%置信区间，6.6至11.0）患者被诊断为MRONJ。仅接受地诺单抗治疗的患者中，MRONJ的发病率为11.6%（95%置信区间，8.0至15.3）；仅接受双膦酸盐治疗的患者中，发病率为2.8%（95%置信区间，0.7至4.8）；接受双膦酸盐治疗后再接受地诺单抗治疗的组中，发病率为16.3%（95%置信区间，8.8至23.9）。接受地诺单抗治疗的患者发生MRONJ的时间明显更早。仅接受地诺单抗治疗的患者，治疗开始后发生MRONJ的时间为4.6年；仅接受双膦酸盐治疗的患者为5.1年；先后接受两种药物治疗的患者为8.4年。
结论
与文献中的现有数据相比，发现乳腺癌骨转移患者的MRONJ发病率相当高，尤其是接受地诺单抗治疗的患者。此外，接受地诺单抗治疗的患者发生MRONJ的时间明显更早。
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