Takeuchi Akihiko, Tsuchiya Hiroyuki, Niu Xiaohui, Ueda Takafumi, Jeon Dae-Geun, Wang Edward H M, Asavamongkolkul Apichat, Kusuzaki Katsuyuki, Sakayama Kenshi, Kang Yong-Koo
Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
J Orthop Sci. 2011 Mar;16(2):196-202. doi: 10.1007/s00776-011-0030-x. Epub 2011 Feb 8.
Giant-cell tumor (GCT) of bone is a common primary benign tumor with high local recurrence and potential distant metastasis or malignant transformation. We have investigated the clinical behavior of recurrent GCT of bone in the extremities.
We retrospectively reviewed 110 patients with recurrent GCTs of bone in the extremities treated by the Eastern Asian Musculoskeletal Oncology Group. The factors that affected the number of recurrences and distant metastasis were analyzed.
The median interval between initial surgery and the first recurrence of GCT was 16 months (2-180 months). All patients received additional surgery for first recurrence. Twenty-five patients had a second recurrence and 6 patients had a third recurrence. The mean interval between the initial surgery and the first recurrence correlated with the eventual number of recurrences-14.1 months for the repeated recurrence groups (two and three recurrences) and 28.3 months for the single recurrence group (p = 0.016). Campanacci grade did not correlate with repeated recurrence (p = 0. 446). The venue of the initial surgery did not correlate with recurrence but did affect preservation of the adjacent joint (chi-squared test; p = 0.046). Campanacci grade II and III also correlated with sacrifice of the adjacent joint (p = 0.020). The incidence of lung metastasis and malignant transformation were 7.5% (8 out of 107 patients) and 2.7% (3 out of 110 patients), respectively. Repeat recurrence was associated with lung metastasis (p = 0.018).
Early local recurrence of GCT is a risk factor for repeat recurrence. Repeat recurrence also correlates with lung metastasis. Recurettage with meticulous adjuvant treatment to completely preclude recurrent lesions is a reasonable method for preserving the adjacent joint. However, a continuous careful follow-up is mandatory.
骨巨细胞瘤（GCT）是一种常见的原发性良性肿瘤，具有较高的局部复发率以及远处转移或恶变的可能性。我们对四肢复发性骨巨细胞瘤的临床行为进行了研究。
我们回顾性分析了东亚肌肉骨骼肿瘤学组治疗的110例四肢复发性骨巨细胞瘤患者。分析了影响复发次数和远处转移的因素。
骨巨细胞瘤初次手术至首次复发的中位间隔时间为16个月（2 - 180个月）。所有患者首次复发时均接受了再次手术。25例患者出现第二次复发，6例患者出现第三次复发。初次手术至首次复发的平均间隔时间与最终复发次数相关——多次复发组（两次和三次复发）为14.1个月，单次复发组为28.3个月（p = 0.016）。坎帕纳奇分级与多次复发无关（p = 0.446）。初次手术的部位与复发无关，但会影响相邻关节的保留情况（卡方检验；p = 0.046）。坎帕纳奇II级和III级也与相邻关节的牺牲相关（p = 0.020）。肺转移和恶变的发生率分别为7.5%（107例患者中的8例）和2.7%（110例患者中的3例）。多次复发与肺转移相关（p = 0.018）。
骨巨细胞瘤早期局部复发是再次复发的危险因素。再次复发也与肺转移相关。采用细致的辅助治疗进行刮除术以完全排除复发病变是保留相邻关节的合理方法。然而，必须进行持续密切的随访。
