リケラボ論文検索は、全国の大学リポジトリにある学位論文・教授論文を一括検索できる論文検索サービスです。

リケラボ 全国の大学リポジトリにある学位論文・教授論文を一括検索するならリケラボ論文検索大学・研究所にある論文を検索できる

リケラボ 全国の大学リポジトリにある学位論文・教授論文を一括検索するならリケラボ論文検索大学・研究所にある論文を検索できる

大学・研究所にある論文を検索できる 「Effectiveness of surgery and hyperbaric oxygen for antiresorptive agent-related osteonecrosis of the jaw: A subgroup analysis by disease stage」の論文概要。リケラボ論文検索は、全国の大学リポジトリにある学位論文・教授論文を一括検索できる論文検索サービスです。
リケラボ

コピーが完了しました

URLをコピーしました

論文の公開元へ論文の公開元へ
書き出し

Effectiveness of surgery and hyperbaric oxygen for antiresorptive agent-related osteonecrosis of the jaw: A subgroup analysis by disease stage

Watanabe, Takuma 京都大学 DOI:10.14989/doctor.r13437

2021.09.24

概要

【背景】ビスフォスフォネート製剤やヒト型抗 RANKL モノクローナル抗体製剤は、固形癌の骨転移、多発性骨髄腫、骨粗鬆症に対して、広く使用されている。ビスフォスフォネートに関連した顎骨壊死（ bisphosphonate-related osteonecrosis of the jaw; BRONJ ） やデノスマブに関連した顎骨壊死（denosumab-related osteonecrosis of the jaw; DRONJ）などが報告され、これらは包括して骨吸収抑制薬関連顎骨壊死（ antiresorptive agent-related osteonecrosis of the jaw; ARONJ）と呼ばれている。ARONJ は口腔内外に骨露出を認める難治性の疾患であり、発生機序は未だ明らかにされておらず、その治療法も議論のあるところである。そこで、ARONJ の治療法のうち、手術と高気圧酸素療法の効果を評価するため、単施設コホート研究を行った。

【方法】京都大学医学部附属病院歯科口腔外科で、2003 年 1 月から 2019 年12 月までに ARONJ Stage2 または 3 と診断された 252 名を対象とした。患者情報より、部位、発症契機、Stage、併存症、手術の種類、高気圧酸素療法の実施回数、原疾患の分類、骨吸収抑制薬の種類・投与期間、休薬の有無を調査した。手術は「腐骨除去術」と「腐骨と周囲骨を含めた切除術」に分類し、高気圧酸素療法は 15 回／サイクルを基準として分類した。そして、ARONJ の治癒をアウトカムとして、Stage2 および 3 のサブグループに分類し、単変量解析（カイ二乗検定、Student’s t-test）および多変量解析（ロジスティック回帰分析）を行った。

【結果】女性 196 名、男性 56 名で、平均年齢は 71.2 歳であった。Stage2 は206 名、Stage3 は 46 名であった。骨粗鬆症患者は 119 名、悪性疾患患者は 133名であった。139 名（55.2％）に治癒を認め、Stage2 の治癒割合（56.3％）は Stage3 の治癒割合（50.0％）よりも少し高かった。手術と高気圧酸素療法を併用した 109 名のうち、88 名が術前後に高気圧酸素療法を受けていた。単変量解析では、全例において、手術（p<0.001）および高気圧酸素量療法（p<0.001）は、ARONJ の治癒に関連を示した。多変量解析では、全例において「腐骨除去術」（OR,18.071; 95%CI,5.723-57.064; p<0.001）と「腐骨と周囲骨を含めた切除術」（OR,64.584; 95%CI,17.057-244.546; p<0.001）が ARONJ の治癒に正の関連を示した。そして、46 回以上の高気圧酸素療法（OR,0.170; 95%CI,0.035- 0.819; p=0.027）および悪性疾患患者（OR,0.200; 95%CI,0.072-0.561; p=0.002）が ARONJ の治癒に負の関連を示した。

【考察】本研究の結果より、「腐骨除去術」と「腐骨と周囲骨を含めた切除術」は治療効果があることが示唆された。また、悪性疾患患者に生じた ARONJ は治癒し難いことが示唆された。そして消炎や腐骨形成・分離を期待して長期間の高気圧酸素療法を受けざるを得ない元来難治性の ARONJ に対しては、新たな治療戦略が必要であると考えられた。

論文の公開元へ

関連論文

関連論文をもっと見る

参考文献

1. Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg. 2003; 61: 1115–1117. https://doi.org/10.1016/s0278-2391 (03)00720-1 PMID: 12966493

2. Fizazi K, Carducci M, Smith M, Damião R, Brown J, Karsh L, et al. Denosumab versus zoledronic acid for treatment of bone metastases in men with castration-resistant prostate cancer: a randomised, dou- ble-blind study. Lancet. 2011; 377: 813–822. https://doi.org/10.1016/S0140-6736(10)62344-6 PMID: 21353695

3. Kuroshima S, Sasaki M, Sawase T. Medication-related osteonecrosis of the jaw: a literature review. J Oral Biosci. 2019; 61: 99–104. https://doi.org/10.1016/j.job.2019.03.005 PMID: 31109863

4. El-Rabbany M, Lam DK, Shah PS, Azarpazhooh A. Surgical management of medication-related osteo- necrosis of the jaw is associated with improved disease resolution: a retrospective cohort study. J Oral Maxillofac Surg. 2019; 77: 1816–1822. https://doi.org/10.1016/j.joms.2019.03.040 PMID: 31054989

5. Vescovi P, Campisi G, Fusco V, Mergoni G, Manfredi M, Merigo E, et al. Surgery-triggered and non sur- gery-triggered bisphosphonate-related osteonecrosis of the jaws (BRONJ): a retrospective analysis of 567 cases in an Italian multicenter study. Oral Oncol. 2011; 47: 191–194. https://doi.org/10.1016/j.oraloncology.2010.11.007 PMID: 21292541

6. Graziani F, Vescovi P, Campisi G, Favia G, Gabriele M, Gaeta GM, et al. Resective surgical approach shows a high performance in the management of advanced cases of bisphosphonate-related osteone- crosis of the jaws: a retrospective survey of 347 cases. J Oral Maxillofac Surg. 2012; 70: 2501–2507. https://doi.org/10.1016/j.joms.2012.05.019 PMID: 22883322

7. Ruggiero SL, Kohn N. Disease stage and mode of therapy are important determinants of treatment out- come for medication-related osteonecrosis of the jaw. J Oral Maxillofac Surg. 2015; 73: S94–S100. https://doi.org/10.1016/j.joms.2015.09.024 PMID: 26608159

8. Kim HY, Lee SJ, Kim SM, Myoung H, Hwang SJ, Choi JY, et al. Extensive surgical procedures result in better treatment outcome for bisphosphonate-related osteonecrosis of the jaw in patients with osteopo- rosis. J Oral Maxillofac Surg. 2017; 75: 1404–1413. https://doi.org/10.1016/j.joms.2016.12.014 PMID: 28039736

9. Hayashida S, Soutome S, Yamamoto S, Fujita S, Hasegawa T, Komori T, et al. Evaluation of the treat- ment strategies for medication-related osteonecrosis of the jaws (MRONJ) and the factors affecting treatment outcome: a multicenter retrospective study with propensity score matching analysis. J Bone Miner Res. 2017; 32: 2022–2029. https://doi.org/10.1002/jbmr.3191 PMID: 28585700

10. Freiberger JJ, Padilla-Burgos R, Chhoeu AH, Kraft KH, Boneta O, Moon RE, et al. Hyperbaric oxygen treatment and bisphosphonate-induced osteonecrosis of the jaw: a case series. J Oral Maxillofac Surg. 2007; 65: 1321–1327. https://doi.org/10.1016/j.joms.2007.03.019 PMID: 17577496

11. Freiberger JJ, Padilla-Burgos R, McGraw T, Suliman HB, Kraft KH, Stolp BW, et al. What is the role of hyperbaric oxygen in the management of bisphosphonate-related osteonecrosis of the jaw: a random- ized controlled trial of hyperbaric oxygen as an adjunct to surgery and antibiotics. J Oral Maxillofac Surg. 2012; 70: 1573–1583. https://doi.org/10.1016/j.joms.2012.04.001 PMID: 22698292

12. Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, et al. American association of oral and maxillofacial surgeons position paper on medication-related osteonecrosis of the jaw-2014 update. J Oral Maxillofac Surg. 2014; 72: 1938–1956. https://doi.org/10.1016/j.joms.2014.04.031 PMID: 25234529

13. Yoneda T, Hagino H, Sugimoto T, Ohta H, Takahashi S, Soen S, et al. Antiresorptive agent-related osteonecrosis of the jaw: position paper 2017 of the Japanese Allied Committee on Osteonecrosis of the Jaw. J Bone Miner Metab. 2017; 35: 6–19. https://doi.org/10.1007/s00774-016-0810-7 PMID: 28035494

14. Nicolatou-Galitis O, Schiødt M, Mendes RA, Ripamonti C, Hope S, Drudge-Coates L, et al. Medication- related osteonecrosis of the jaw: definition and best practice for prevention, diagnosis, and treatment. Oral Surg Oral Med Oral Pathol Oral Radiol. 2019; 127: 117–135. https://doi.org/10.1016/j.oooo.2018.09.008 PMID: 30393090

15. Jasper V, Laurence V, Maximiliaan S, Ferri J, Nicot R, Constantinus P. Medication-related osteonecro- sis of the jaw (MRONJ) stage Ⅲ: conservative and conservative surgical approaches versus an aggres- sive surgical intervention: a systematic review. J Craniomaxillofac Surg. 2020; 48: 435–443. https://doi. org/10.1016/j.jcms.2020.02.017 PMID: 32178949

16. So¨ zen T, O¨ zişik L, Başaran NC¸ . An overview and management of osteoporosis. Eur J Rheumatol. 2017; 4: 46–56. https://doi.org/10.5152/eurjrheum.2016.048 PMID: 28293453

17. Coleman R, Body JJ, Aapro M, Hadji P, Herrstedt J; ESMO Guidelines Working Group. Bone health in cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol. 2014; 25: 124–137. https://doi.org/10. 1093/annonc/mdu103 PMID: 24782453

18. Khan AA, Morrison A, Hanley DA, Felsenberg D, McCauley LK, O’Ryan F, et al. Diagnosis and manage- ment of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res. 2015; 30: 3–23. https://doi.org/10.1002/jbmr.2405 PMID: 25414052

19. Khan AA, Sa´ndor GK, Dore E, Morison AD, Alsahli M, Amin F, et al. Canadian consensus practice guidelines for bisphosphonate associated osteonecrosis of the jaw. J Rheumatol. 2008; 35: 1391– 1397. PMID: 18528958

20. Hellstein JW, Adler RA, Edwards B, Jacobsen PL, Kalmar JR, Koka S, et al. Managing the care of patients receiving antiresorptive therapy for prevention and treatment of osteoporosis: executive sum- mary of recommendations from the American Dental Association Council on Scientific Affairs. J Am Dent Assoc. 2011; 142: 1243–1251. https://doi.org/10.14219/jada.archive.2011.0108 PMID: 22041409

21. Zirk M, Kreppel M, Buller J, Pristup J, Peters F, Dreiseidler T, et al. The impact of surgical intervention and antibiotics on MRONJ stage Ⅱ and Ⅲ - Retrospective study. J Craniomaxillofac Surg. 2017; 45: 1183–1189. https://doi.org/10.1016/j.jcms.2017.05.027 PMID: 28684074

22. Albanese M, Zotti F, Capocasale G, Bonetti S, Lonardi F, Nocini PF. Conservative non-surgical man- agement in medication related osteonecrosis of the jaw: A retrospective study. Clin Exp Dent Res. 2020; 6: 512–518. https://doi.org/10.1002/cre2.303 PMID: 32614524

23. Ewald F, Wuesthoff F, Koehnke R, Friedrich RE, Gosau M, Smeets R, et al. Retrospective analysis of bacterial colonization of necrotic bone and antibiotic resistance in 98 patients with medication-related osteonecrosis of the jaw (MRONJ). Clin Oral Investig. 2020 Oct 2. https://doi.org/10.1007/s00784-020- 03595-9 PMID: 33006027

24. Akashi M, Kusumoto J, Takeda D, Shigeta T, Hasegawa T, Komori T. A literature review of periopera- tive antibiotic administration in surgery for medication-related osteonecrosis of the jaw. Oral Maxillofac Surg. 2018; 22: 369–378. https://doi.org/10.1007/s10006-018-0732-8 PMID: 30327979

25. Rupel K, Ottaviani G, Gobbo M, Contardo L, Tirelli G, Vescovi P, et al. A systematic review of therapeu- tical approaches in bisphosphonates-related osteonecrosis of the jaw (BRONJ). Oral Oncol. 2014; 50: 1049–1057. https://doi.org/10.1016/j.oraloncology.2014.08.016 PMID: 25240948

26. Boykin JV Jr, Baylis C. Hyperbaric oxygen therapy mediates increased nitric oxide production associ- ated with wound healing: a preliminary study. Adv Skin Wound Care. 2007; 20: 382–388. https://doi. org/10.1097/01.ASW.0000280198.81130.d5 PMID: 17620739

27. Allen BW, Demchenko IT, Piantadosi CA. Two faces of nitric oxide: implications for cellular mechanisms of oxygen toxicity. J Appl Physiol. 2009; 106: 662–667. https://doi.org/10.1152/japplphysiol.91109. 2008 PMID: 18845774

28. Sacco R, Leeson R, Nissan J, Olate S, de Castro CH, Acocella A, et al. A systematic review of oxygen therapy for the management of medication-related osteonecrosis of the jaw (MRONJ). Appl Sci. 2019; 9: 1026–1048.

29. Marx RE. A new concept in the treatment of osteoradionecrosis. J Oral Maxillofac Surg. 1983; 41: 351–357. https://doi.org/10.1016/s0278-2391(83)80005-6 PMID: 6574217

30. Grisar K, Schol M, Schoenaers J, Dormaar T, Coropciuc R, Vander Poorten V, et al. Osteoradionecro- sis and medication-related osteonecrosis of the jaw: similarities and differences. Int Oral Maxillofac Surg. 2016; 45: 1592–1599. https://doi.org/10.1016/j.ijom.2016.06.016 PMID: 27427547

31. Shimura K, Shimazaki C, Taniguchi K, Akamatsu S, Okamoto M, Uchida R, et al. Hyperbaric oxygen in addition to antibiotic therapy is effective for bisphosphonate-induced osteonecrosis of the jaw in a patient with multiple myeloma. Int J Hematol. 2006; 84: 343–345. https://doi.org/10.1532/IJH97.06110 PMID: 17118761

32. Fatema CN, Sato J, Yamazaki Y, Hata H, Hattori N, Shiga T, et al. FDG-PET may predict the effective- ness of hyperbaric oxygen therapy in a patient with bisphosphonate-related osteonecrosis of the jaw: report of a case. Odontology. 2015; 103: 105–108. https://doi.org/10.1007/s10266-013-0129-y PMID: 23907202

33. Lee CYS, David T, Nishime M. Use of platelet-rich plasma in the management of oral bisphosphonate- associated osteonecrosis of the jaw: a report of 2 cases. J Oral Implantol. 2007; 33: 371–382. https:// doi.org/10.1563/1548-1336(2007)33[371:UOPPIT]2.0.CO;2 PMID: 18240798

34. Lee CYS, Pien FD, Suzuki JB. Identification and treatment of bisphosphonate-associated actinomycotic osteonecrosis of the jaws. Implant Dent. 2011; 20: 331–336. https://doi.org/10.1097/ID. 0b013e3182310f03 PMID: 21881516

参考文献をもっと見る

全国の大学の
卒論・修論・学位論文
を
一発検索！

この論文の関連論文を見る