Single-center analysis of antiresorptive agent-related osteonecrosis of the jaw in lung cancer patients
Single-center analysis of antiresorptive agent-related osteonecrosis of the jaw in lung cancer patients
复制标题
肺癌患者抗骨吸收剂相关颌骨坏死的单中心分析
DOI：
10.1111/ajco.13395
复制
发表时间：
2020
影响因子：
1.9
通讯作者：
Mio T
中科院分区：
文献类型：
--
作者：
Okamura M;Fujita K;Yamamoto Y;Kanai O;Nakatani K;Horimoto K;Hashimoto M;Sawai S;Shimosato M;Yoshida K;Mio T
背景在过去的二十年中，抗骨吸收剂相关的颌骨坏死（ARONJ）已成为越来越令人关注的问题。我们检查了 ARONJ 的发病率，并在现实临床环境中确定了肺癌患者的危险因素。据我们所知，我们是第一个这样做的。患者和方法我们回顾性分析了2012年10月至2018年9月在国立医院组织京都医疗中心接受抗骨吸收药物（唑来膦酸或地诺塞麦）的肺癌骨转移患者。所有ARONJ病例均由牙科医生根据既定的诊断标准诊断。结果总共审查了171名患者，其中13名（7.6％）经历了骨转移阿龙杰。 13 名患者中，分别有 6 名（46.2%）、4 名（30.8%）和 3 名（23.1%）患有腺癌、鳞癌和未特指的癌症。 3 名患者 (23.1%) 处于 ARONJ 2 期，10 名患者 (76.9%) 处于 3 期。更多抗骨吸收药物周期（比值比 [OR] = 11.54；95% 置信区间 [CI]，2.47–53.99；P< 0.01）、使用免疫检查点抑制剂（ICIs；OR = 5.05；95% CI，1.56–16.37；P< 0.01）和更长的生存时间（≥2 年；OR =多变量分析中，ARONJ（12.16；95% CI，3.17-46.65；P<0.01）与 ARONJ 独立相关。结论 肺癌骨转移患者中 ARONJ 的发生率相对较高。使用抗骨吸收药物时，肿瘤科医生应在治疗过程中密切监测患者的 ARONJ 情况，并定期咨询牙医，特别是接受 ICI 的患者。
BackgroundOver the past two decades, antiresorptive agent‐related osteonecrosis of the jaw (ARONJ) has become a growing concern. We examined the incidence of ARONJ and identified its risk factors in lung cancer patients in the real‐world clinical setting. To our knowledge, we are the first to do so.Patients and methodsWe retrospectively analyzed lung cancer patients with bone metastases who had received anti‐resorptive agents (zoledronate or denosumab) at the National Hospital Organization Kyoto Medical Center from October 2012 to September 2018. All ARONJ cases were diagnosed by the dentists according to the established diagnostic criteria.ResultsA total of 171 patients were reviewed, 13 (7.6%) of whom experienced ARONJ. Among the 13 patients, six (46.2%), four (30.8%) and three (23.1%) had adenocarcinoma, squamous carcinoma and not otherwise specified, respectively. ARONJ was stage 2 in three (23.1%) patients and stage 3 in 10 (76.9%). More cycles of antiresorptive agents (odds ratio [OR] = 11.54; 95% confidence interval [CI], 2.47–53.99;P< 0.01), use of immune checkpoint inhibitors (ICIs; OR = 5.05; 95% CI, 1.56–16.37;P< 0.01) and longer survival duration (≥2 years; OR = 12.16; 95% CI, 3.17–46.65;P< 0.01) were independently associated with ARONJ in a multivariate analysis.ConclusionsThe incidence of ARONJ was relatively high in lung cancer patients with bone metastases. When using antiresorptive agents, oncologists should closely monitor patients for ARONJ during the course of treatment and regularly consult with dentists, especially in patients receiving ICIs.