骨修飾薬による癌治療を受けている患者における抜歯と薬物関連顎骨壊死の発症との関連についての調査

Survey of the association between tooth extraction and development of medication-related osteonecrosis of the jaw in patients undergoing cancer treatment with bone-modifying agents.

抄録

目的:

本研究の目的は、骨修飾剤（BMA）投与前の抜歯が薬剤性顎骨壊死（MRONJ）の発症予防に有効であるか否かを検証することである。

OBJECTIVE: This study aimed to verify whether tooth extraction before the administration of bone-modifying agents (BMA) was effective in preventing the onset of medication-related osteonecrosis of the jaw (MRONJ).

材料と方法:

本レトロスペクティブ研究は、がん治療でBMAを投与された既往のある患者を対象とした。MRONJ発症前の抜歯なし、BMA投与前の抜歯あり、BMA投与後の抜歯ありの3群に分類した。MRONJの発生率を群間で比較した。3群間の割合の差の検定には、フィッシャーの正確検定とボンフェローニ補正を用いた。

MATERIALS AND METHODS: This retrospective study included patients with a history of receiving BMA for cancer treatment. The patients were classified into three groups based on the timing of tooth extraction: no tooth extraction before the onset of MRONJ, tooth extraction before the administration of BMA, and tooth extraction after the administration of BMA. The incidence of MRONJ was compared between the groups. Fisher's exact test and Bonferroni correction were used to test for differences in proportions between the three groups.

結果:

被験者総数は123人であった。24例（19.5％）がMRONJを発症した。発症率は、非抜歯群12.3％（10/81例）、BMA投与前抜歯群17.9％（5/28例）、BMA投与後抜歯群64.3％（9/14例）であり、BMA投与後抜歯群と非抜歯群、BMA投与後抜歯群とBMA投与前抜歯群でそれぞれ統計学的有意差が認められた（p＜0.001、p＝0.0049）。一方、非抜歯群とBMA投与前抜歯群では、発生率に統計学的有意差は認められなかった（p=0.5274）。

RESULTS: The total number of subjects was 123. Twenty-four patients (19.5%) developed MRONJ. The incidence rates were 12.3% (10/81), 17.9% (5/28), and 64.3% (9/14) in the non-extraction group, the extraction before BMA administration group, and the extraction after BMA administration group, respectively, showing statistically significant differences between the extraction after BMA administration group and the non-extraction groups and between the extraction after BMA administration group and the extraction before BMA administration group (p < 0.001, p = 0.0049). On the other hand, there was no statistically significant difference in incidence between the non-extraction and the extraction before BMA administration group (p = 0.5274).

結論:

BMA投与前の抜歯は、がん治療でBMAを投与されている患者のMRONJ発症予防に有効である。がん治療でBMA投与を受けている患者のMRONJ発症予防は、患者のQOL維持に寄与する。

CONCLUSIONS: Tooth extraction before the administration of BMA is effective in preventing the onset of MRONJ in patients receiving BMA for cancer treatment. Prevention of MRONJ development in patients receiving BMA for cancer treatment contributes to the maintenance of patients' quality of life.