GIANT-CELL TUMOR OF BONE
GIANT-CELL TUMOR OF BONE
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DOI：
10.2106/00004623-198769010-00018
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发表时间：
1987-01-01
影响因子：
5.3
通讯作者：
SUDANESE, A
中科院分区：
文献类型：
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作者：
CAMPANACCI, M;BALDINI, N;SUDANESE, A
在里佐利研究所看到的327名患有骨巨细胞瘤的患者中，293人在研究所接受了治疗，其中280人接受了2到44年的随访。按患者性别、年龄和肿瘤部位的分布与大系列主要报告中的分布相似。肿瘤通常累及干骺端和骨骺，但偶尔也局限于干骺端，只有2%的患者邻近开放的生长板。肿瘤有时侵犯关节间隙，也累及韧带和滑膜。5%的肿瘤通过关节延伸到邻近的骨。我们的放射学分级与Enneking等人的分期系统大致相当，在治疗前266名患者中，I级占4%，II级占74%，III级占22%。9%的患者在第一张X光片上有明显的病理性骨折。在280例获得充分随访的患者中，共进行了331例手术。在151个病灶内手术中，局部复发率为27%，在122个边缘切除手术中，局部复发率为8%，而在58个广泛或根治性手术中，局部复发率为零。这些结果与病变的放射学分级无关。在我们机构治疗后发现的51例局部复发中，90%出现在手术后的头三年。其余10%的患者在术后长达9年的时间内发育。对20例良性骨巨细胞瘤及其后遗症进行了消融手术。在这些患者中，有6名患者的适应症是先前手术或放射治疗的并发症，而在另外7名患者中，先前手术的不足是导致截肢的重要因素。有6名患者(2%)出现肺转移，其中3名患者经组织学证实：所有6名患者都有良好的预后。在10名患者(3.5%)中，肉瘤发生在先前报道的良性肿瘤部位，其中8名患者接受了超过4000拉德的辐射作为辅助。肉瘤发生的时间间隔为2.5至15年。在接受4000拉德以上放射治疗的27名患者中，有8人(27%)发展为肉瘤，他们的预后很差。
Of 327 patients who had a giant-cell tumor of bone and were seen at the Istituto Rizzoli, 293 were treated at the Institute, and 280 of these were followed for two to forty-four years. The distribution according to sex and age of the patient and site of the tumor was similar to the distributions in major reports of large series. The tumor usually involved the metaphysis and the epiphysis, but was occasionally limited to the metaphysis, and in only 2 per cent of the patients was it adjacent to an open growth plate. The tumor on occasion invaded the articular space, also involving the ligaments and the synovial membrane. Extension to an adjacent bone through the joint occurred in 5 per cent of the tumors. Our radiographic grading, which is roughly comparable with the staging system of Enneking et al., was Grade I in 4 per cent, II in 74 per cent, and III in 22 per cent of 266 patients before treatment. A pathological fracture was apparent on the first radiograph in 9 per cent of the patients. In the 280 patients with adequate follow-up, 331 surgical procedures were performed. The rate of local recurrence was 27 per cent in the 151 intralesional procedures, 8 per cent in the 122 marginal excisions, and zero in the fifty-eight wide or radical procedures. These results did not correlate with the radiographic grade of the lesion. Of the fifty-one local recurrences that were seen after treatment at our institution, 90 per cent appeared in the first three years after surgery. The remaining 10 per cent developed as long as nine years postoperatively. Ablative surgery for benign giant-cell tumor and its sequelae was performed in twenty patients. In six of these patients the indication was a complication of previous surgical or radiation therapy, and in seven other patients the inadequacy of previous surgery was an important factor leading to amputation. Lung metastases appeared in six patients (2 per cent) and were proved histologically in three: all six patients had a favorable outcome. In ten patients (3.5 per cent) a sarcoma developed at the site of a previously documented benign tumor eight of these patients had received radiation exceeding 4000 rads as an adjuvant. The sarcomas occurred after an interval of 2.5 to fifteen years. Of the twenty-seven patients who underwent radiation therapy with more than 4000 rads, a sarcoma developed in eight (27 per cent), and their prognosis was poor.