WHAT ARE THE MAIN CLINICAL FEATURES OF ONCOLOGICAL PATIENTS WITH MRONJ? A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Objective To integrate the data published on patients with cancer who underwent antiresorptive drug (ARD) therapy and developed MRONJ into a comprehensive analysis of clinical features, and to evaluate if some clinical factors could influence MRONJ staging. Study Design An electronic search was performed, followed by descriptive analyses of the clinical pathological data. Poisson regression was used to evaluate the predictors of the MRONJ stage. Results In total, 1,598 cases were included. Most cases were reported in women, and the mean age was 66.45±10.5 years. Integumentary system cancer was the main reason for using ARDs, and metastasis occurred in 65.5% (n=436) patients. The most common etiology of MRONJ was traumatic events. MRONJ stage 2 was the most prevalent. Bisphosphonate monotherapy or combination therapy was used in 77.3% (n: 419) of the cases, while denosumab was used in 14.4% cases (n=77). Poisson regression analysis demonstrated that the MRONJ stage was not affected by comorbidities, metastasis, duration of ARD use, or the primary neoplasm site. Conclusion Nitrogen-containing bisphosphonates (used alone or in combination) are the most common ARDs associated with MRONJ in patients with cancer. Moreover, the primary neoplasm site, as well as metastasis, do not interfere in MRONJ staging. To integrate the data published on patients with cancer who underwent antiresorptive drug (ARD) therapy and developed MRONJ into a comprehensive analysis of clinical features, and to evaluate if some clinical factors could influence MRONJ staging. An electronic search was performed, followed by descriptive analyses of the clinical pathological data. Poisson regression was used to evaluate the predictors of the MRONJ stage. In total, 1,598 cases were included. Most cases were reported in women, and the mean age was 66.45±10.5 years. Integumentary system cancer was the main reason for using ARDs, and metastasis occurred in 65.5% (n=436) patients. The most common etiology of MRONJ was traumatic events. MRONJ stage 2 was the most prevalent. Bisphosphonate monotherapy or combination therapy was used in 77.3% (n: 419) of the cases, while denosumab was used in 14.4% cases (n=77). Poisson regression analysis demonstrated that the MRONJ stage was not affected by comorbidities, metastasis, duration of ARD use, or the primary neoplasm site. Nitrogen-containing bisphosphonates (used alone or in combination) are the most common ARDs associated with MRONJ in patients with cancer. Moreover, the primary neoplasm site, as well as metastasis, do not interfere in MRONJ staging.