Managements of giant cell tumor within the distal radius: A retrospective study of 58 cases from a single center
Managements of giant cell tumor within the distal radius: A retrospective study of 58 cases from a single center
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DOI：
10.1016/j.jbo.2018.100211
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发表时间：
2019-02-01
影响因子：
3.4
通讯作者：
Shen, Jingnan
中科院分区：
文献类型：
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作者：
Zou, Changye;Lin, Tiao;Shen, Jingnan
背景：桡骨远端骨巨细胞瘤是一种侵袭性强、复发率高的良性侵袭性骨肿瘤。方法：收集本中心58例桡骨远端骨巨细胞瘤患者的临床资料，分析其潜在的肿瘤和治疗相关因素、术后肿瘤学和功能结果，以明确复发相关危险因素，制定合适的手术策略。结果：根据现有资料，我们的分析强烈提示了骨巨细胞瘤的软组织扩张(有无，HR：5.645，95%CI：1.424~22.377，P=0.014)和GCTB的大小(直径和GT；=5cmvs.5cmHR：3.893，95%CI：1.109~13.659，p=0.034)是局部复发的两个独立危险因素。无论是手术方式(刮除还是整块切除)或其他因素(包括年龄、肿瘤性质、优势手受累、病理性骨折情况或术前单抗)均不明显影响复发。然而，与切除组相比，病灶内刮除术组获得了更好的功能评分(VAS2.5+/-0.8vs.3.6+/-1.2，P=0.011；MSTS20.2+/-3.4vs.16.7+/-3.8，P=0.034；DASH9.1+/-3.9vs.16.4+/-5.5，P=0.030)，并发症(骨不连、脱位、骨折和感染)也明显减少。结论：放射学表现(软组织范围和肿瘤大小)是预测桡骨远端GCTB局部复发的重要预后指标。在大多数肿瘤中，刮除的初始治疗仍然是可行的和首选的，特别是辅助性的Denosumab。
Background: Giant cell tumor of bone (GCTB) in distal radius is a benign but invasive bone tumor characterized by strong aggressive behavior and frequent recurrence.Methods: To identify recurrence related risk factors and decide suitable surgical strategy, the potential tumor-and treatment-specific factors, post-operative oncologic and functional outcomes were collected and analyzed from 58 patients with GCTB of the distal radius at our center.Results: With the numbers available, our analysis strongly indicated soft tissue extension (with vs. without, HR: 5.645, 95% CI: 1.424 to 22.377, p = 0.014) and size of GCTB (diameter >= 5 cm vs. 5 cm HR: 3.893, 95% CI: 1.109 to 13.659, p = 0.034) are the two independent risk factors related to local relapse. Neither surgical procedures (curettage vs. en-bloc resection) nor other factors apparently affected the recurrence, including age, tumor nature, dominant hand involvement, pathological fracture conditions or pre-operative denosumab. However, intralesional curettage group achieved much better functional scores ((VAS: 2.5 +/- 0.8 vs. 3.6 +/- 1.2, p = 0.011; MSTS: 20.2 +/- 3.4 vs. 16.7 +/- 3.8, P = 0.034; DASH 9.1 +/- 3.9 vs. 16.4 +/- 5.5, p = 0.030) and much less complications (non-unions, dislocations, fractures and infections) compared to resection ones. Furthermore, denosumab provided dramatic pain reduction and strong tumor suppression, facilitating curettage with local adjuvants even in GCTB with advanced status.Conclusions: Taken together, the radiographic presentations (soft-tissue extension and tumor size) are the strong prognostic predictors of local recurrence of GCTB in distal radius. In most tumors, an initial treatment with curettage remains feasible and first-choice, especially with the adjuvant denosumab.