Resnick Cory M, Margolis Jeffrey, Susarla Srinivas M, Schwab Joseph H, Hornicek Francis J, Dodson Thomas B, Kaban Leonard B
Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA 02114, USA.
J Oral Maxillofac Surg. 2010 Jan;68(1):130-7. doi: 10.1016/j.joms.2009.04.106.
The relationship between giant cell lesions (GCLs) of the maxillofacial (MF) skeleton and those of the axial/appendicular (AA) skeleton has been long debated. The present study compared the clinical and radiographic characteristics of subjects with MF and AA GCLs.
This was a retrospective cohort study of patients treated for GCLs at Massachusetts General Hospital from 1993 to 2008. The predictor variables included tumor location (MF or AA) and clinical behavior (aggressive or nonaggressive). The outcome variables included demographic, clinical, and radiographic parameters, treatments, and outcomes. Descriptive and bivariate statistics were computed, and P <or= .05 was considered significant.
The sample included 93 subjects: 45 with MF (38 with aggressive and 7 with nonaggressive) and 48 with AA (30 with aggressive and 18 with nonaggressive). Comparing the patients with MF and AA GCLs, those with MF lesions presented younger (P < .001), and the lesions were more commonly asymptomatic (P < .001), smaller (P < .001), and managed differently (P < .001) than AA lesions. When stratified by clinical behavior, aggressive tumors were diagnosed earlier than nonaggressive tumors (P < .001). Controlling for location and clinical behavior, patients with MF aggressive lesions were younger (P < .001) than those with AA aggressive lesions. MF nonaggressive lesions were more commonly asymptomatic (P = .04), smaller (P = .05), and less commonly locally destructive (P = .05) than AA nonaggressive lesions.
These results suggest that MF and AA GCLs represent a similar, if not the same, disease. Comparing the aggressive and nonaggressive subgroups, more similarities were found than when evaluating without stratification by clinical behavior. The remaining differences could be explained by the likelihood that MF tumors are diagnosed earlier than AA tumors because of facial exposure and dental screening examinations and radiographs.
颌面部（MF）骨骼巨细胞病变（GCLs）与中轴/附属（AA）骨骼巨细胞病变之间的关系长期以来一直存在争议。本研究比较了MF和AA GCLs患者的临床和影像学特征。
这是一项对1993年至2008年在马萨诸塞州总医院接受GCLs治疗的患者进行的回顾性队列研究。预测变量包括肿瘤位置（MF或AA）和临床行为（侵袭性或非侵袭性）。结果变量包括人口统计学、临床和影像学参数、治疗方法及结果。计算描述性和双变量统计量，P≤0.05被认为具有统计学意义。
样本包括93名受试者：45名患有MF GCLs（38名侵袭性和7名非侵袭性），48名患有AA GCLs（30名侵袭性和18名非侵袭性）。比较MF和AA GCLs患者，MF病变患者更年轻（P<0.001），病变更常无症状（P<0.001）、更小（P<0.001），且治疗方式与AA病变不同（P<0.001）。按临床行为分层时，侵袭性肿瘤比非侵袭性肿瘤诊断更早（P<0.001）。在控制位置和临床行为后，MF侵袭性病变患者比AA侵袭性病变患者更年轻（P<0.001）。MF非侵袭性病变比AA非侵袭性病变更常无症状（P = 0.04）、更小（P = 0.05），且局部破坏性更少见（P = 0.05）。
这些结果表明，MF和AA GCLs代表一种相似的疾病，即便不是同一种疾病。比较侵袭性和非侵袭性亚组时，发现的相似之处比未按临床行为分层评估时更多。其余差异可能是由于MF肿瘤因面部暴露以及牙科筛查检查和X光片而比AA肿瘤更早被诊断。
