Factors affecting development of medication-related osteonecrosis of the jaw in cancer patients receiving high-dose bisphosphonate or denosumab therapy: Is tooth extraction a risk factor?
Factors affecting development of medication-related osteonecrosis of the jaw in cancer patients receiving high-dose bisphosphonate or denosumab therapy: Is tooth extraction a risk factor?
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DOI：
10.1371/journal.pone.0201343
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Umeda M
中科院分区：
文献类型：
--
作者：
Soutome S;Hayashida S;Funahara M;Sakamoto Y;Kojima Y;Yanamoto S;Umeda M
尚未建立预防接受高剂量双膦酸盐（BP）或狄诺塞单抗（Dmab）治疗的癌症患者发生药物相关性颌骨骨坏死（MRONJ）的方法。开始用药后拔牙被认为是MRONJ的主要风险因素，因此倾向于避免这种手术。本研究调查了MRONJ的危险因素，特别是拔牙与MRONJ发展之间的相关性。135例接受高剂量BP或Dmab给药的癌症患者入组研究。人口统计学因素，一般情况，治疗因素和牙科检查结果进行了回顾性研究，使用医疗记录和全景X线检查结果。采用Kaplan-Meier法计算MRONJ的累积发生率，并采用单因素和多因素考克斯回归分析这些变量与MRONJ发生的相关性。135例患者中有18例发生MRONJ。1年、2年和3年累积发生率分别为8.6%、21.5%和29.2%。首次就诊前的用药时间和有临床症状的牙齿的存在与MRONJ的发展显著相关。有临床症状的牙齿，但谁没有进行拔牙的患者中，MRONJ的发生率变得更高，2年后，比有症状的牙齿进行拔牙的患者，但不显着。早期牙科检查和有效的预防性护理，以避免感染/炎症是预防MRONJ的重要。
Methods for preventing medication-related osteonecrosis of the jaw (MRONJ) in cancer patients who have received high-dose bisphosphonate (BP) or denosumab (Dmab) have not yet been established. Tooth extraction after starting medication has been believed to be a major risk factor for MRONJ, and therefore this procedure tends to be avoided. This study investigated the risk factors for MRONJ, with a special reference to the correlation between tooth extraction and development of MRONJ. One hundred and thirty-five cancer patients who were administrated high-dose BP or Dmab were enrolled in the study. Demographic factors, general condition, treatment factors, and dental findings were examined retrospectively using medical records and panoramic X-ray findings. The cumulative occurrence rate of MRONJ was calculated using the Kaplan–Meier method, and the correlation between these variables and development of MRONJ was analyzed by univariate and multivariate Cox regression analysis. MRONJ developed in 18 of 135 patients. The 1-, 2-, and 3-year cumulative occurrence rates were 8.6%, 21.5%, and 29.2%, respectively. The duration of medication before first visit to the dental unit and the presence of a tooth with clinical symptoms were significantly correlated with the development of MRONJ. The rate of MRONJ occurrence in patients who had teeth with clinical symptoms, but who did not undergo tooth extraction, became higher 2 years later than that in patients who underwent extraction of teeth with symptoms, although not significant. Early dental examination and effective preventative care to avoid infection/inflammation are important for preventing MRONJ.
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