薬物関連顎骨壊死の外科的治療と保存的治療。複雑なシステマティックレビューとメタアナリシス

Surgical vs conservative treatment of medication-related osteonecrosis of the jaw: A complex systematic review and meta-analysis.

抄録

目的:

本研究の目的は、薬物関連顎骨壊死に対する外科的治療アプローチと保存的治療アプローチの転帰を比較することであった。

OBJECTIVE: The objective of this study was to compare the outcome of surgical and conservative treatment approaches for medication-related osteonecrosis of the jaw.

研究デザイン:

Medline, The Cochrane Library, EMBASE, PubMed (non-indexed articles) および医療技術評価機関による出版物を検索した。一次研究のエビデンスの質はGRADE（Grading of Recommendations Assessment, Development and Evaluation）により、システマティックレビューの偏り度はAMSTAR（Measurement Tool to assess systematic reviews）により評価された。

STUDY DESIGN: Publications in Medline, The Cochrane Library, EMBASE, and PubMed (non-indexed articles) and by Health Technology Assessment organizations were searched. Quality of evidence in primary studies were assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) and the level of bias in systematic reviews by a measurement tool to assess systematic reviews (AMSTAR).

結果:

品質評価により、GRADEスコアが中程度の主要研究3件が特定された。メタ解析には9件の研究が含まれ、外科的治療後の治癒率は62.1％（対象患者232名中144名）、保存的治療後の治癒率は28.8％（対象患者132名中38名）と報告された。含まれる研究間で中程度の異質性が認められた（P=.02）。外科的治療と保存的治療後の骨壊死の治癒に関する全体のオッズ比は1.25（95％信頼区間、0.24-2.26）であり、統計的に有意な差はなかった。

RESULTS: Quality assessment identified 3 primary studies with moderate GRADE score. Moderate risk of bias was found in 7 systematic reviews and low risk of bias in 3. Nine studies were included in the meta-analysis, where 62.1% healing was reported after surgical treatment (144 of 232 included patients) and 28.8% healing was reported after conservative treatment (38 of 132 included patients). Moderate heterogeneity was found among the included studies (P = .02). The overall odds ratio for resolution of osteonecrosis after surgical versus conservative treatment was 1.25 (95% confidence interval, 0.24-2.26) and was not statistically significant.

結論:

外科的治療後、特に進行した病期では、わずかに良好な転帰が報告されているが、標準化された治療プロトコールや転帰尺度がない。全体として、エビデンスの質は低く、大半の研究でエビデンスの確実性の評価が低く、バイアスのリスクが高い。

CONCLUSION: Slightly better outcomes are reported after surgical treatment, in particular for advanced disease stages, but there is a lack of standardized treatment protocols and outcome measures. Overall, the quality of evidence is poor, and the majority of studies have a low evidence certainty rating and high risk of bias.