癌症骨骼轉移及多發性骨髓瘤患者藥物相關顎骨壞死併發症之預後因子探討

Prognostic Factors of Medication-Related Osteonecrosis of the Jaws in Metastatic Cancer and Multiple Myeloma Patients

李晏青(Yen-Ching Lee)

指導教授 ： 李正喆

國立臺灣大學/醫學院/臨床牙醫學研究所/碩士(2020年)

https://doi.org/10.6342/NTU202002478

摘要

本研究的主要目的，是探討癌症骨轉移患者，使用兩種不同的抗骨吸收藥物（卓骨祂和癌骨瓦），產生顎骨壞死併發症之預後因子。回溯了225個在台大醫院治療顎骨壞死併發症病灶的癌症骨轉移患者，總共299個病灶，利用統計方法分析其治療結果和影響預後的相關因子。完全癒合比率是採用存活分析中的Kaplan-Meier曲線計算，顯著與否則以Log-rank test和Breslow test標示；Cox單變數及多變數分析則用來探討相關的預後因子。所有299個病灶在治療12個月時的累積完全癒合比率為45.4%，其中使用卓骨祂者為42.2%，使用癌骨瓦者為58.2%。性別、病灶部位、類固醇使用、抗骨吸收藥物種類、用藥時間長短、血中骨膠原蛋白碳末端肽鏈數值以及癌症類別等因素，在Cox多變數分析中是顯著影響預後的因子。除了整體299個病灶一同分析之外，也將同樣的統計方式，依不同癌症類別，分開作分析。整體而言，和使用卓骨祂的病灶相比，使用癌骨瓦的病灶，有較佳的預後。

關鍵字

癌症骨轉移 ； 顎骨壞死併發症 ； 卓骨祂 ； 癌骨瓦 ； 預後因子

並列摘要

The aim of this study is to find out the prognosis of medication-related osteonecrosis of the jaws（MRONJ） in metastatic cancer patients who received two different type of antiresorptive agents for bone metastasis. We retrospectively surveyed 225 metastatic cancer patients with 299 MRONJ lesions treated in National Taiwan University Hospital. Treatment outcomes and prognostic factors were investigated. The cumulative complete response rate was calculated with the Kaplan-Meier method, and significance was examined with the Log-rank and Breslow tests. Cox regression was used for univariate and multivariate analysis of prognostic factors. The cumulative complete response rate of all 299 lesions at 12 months was 45.4%, and that of patients treated with zolendronic acid and denosumab were 42.2% and 58.2%, respectively. Gender, lesion site, steroid usage, drug type, drug duration, CTX level, and cancer type were prognostic factors in a multivariate analysis. We also carried out the same analysis in individual cancer groups. Compared to zolendronic acid（Zometa）, using denosumab（Xgeva） as the antiresorptive agent indicate a better treatment outcome of MRONJ in metastatic cancer patients.

並列關鍵字

Bone metastasis ； medication-related osteonecrosis of the jaws ； zolendronic acid ； denosumab ； prognostic factors

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