Combined antiresorptive and antiangiogenic therapy versus antiresorptive monotherapy: Impact on the surgical prognosis of MRONJ patients with advanced malignancies.

Abstract

For patients with advanced cancer and bone metastasis, antiresorptive medications (ARMs) and antiangiogenic medications (AGMs) are commonly employed to manage tumor progression and skeletal complications. This study evaluates the effects of distinct pharmacotherapeutic strategies-ARM monotherapy versus ARM+AGM combined therapy on surgical outcomes of medication-related osteonecrosis of the jaw (MRONJ) in this population. A retrospective cohort analysis was conducted on 157 patients: 106 received ARM monotherapy, and 51 underwent combined ARM+AGM treatment. Demographic data, MRONJ clinical characteristics, and quality of life (QoL) metrics were systematically collected and analyzed using univariate and multivariate statistical methods. Univariate analysis revealed that the ARM group had a higher proportion of females, longer antiresorptive therapy duration, and more favorable outcomes, including reduced postoperative pain and improved QoL compared to the ARM+AGM group. Multivariate analysis demonstrated that the ARM+AGM group exhibited a 2.8-fold recurrence risk relative to the ARM group, with prognosis significantly influenced by medication strategy, disease stage, and surgical approach. These findings indicate that combined ARM+AGM therapy is associated with a poorer prognosis and heightened recurrence risk in MRONJ patients compared to ARM monotherapy.