Chanchairujira Kullanuch, Jiranantanakorn Titiporn, Phimolsarnti Rapin, Asavamongkolkul Apichat, Waikakul Saranatra
Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University Bangkok, Thailand.
J Med Assoc Thai. 2011 Oct;94(10):1230-7.
To evaluate the relationship between local recurrence of giant cell tumor (GCT) after surgical treatments and plain radiography, pathology grade and surgical procedures.
Patients with pathologically proven primary giant cell tumor of long bones, who underwent surgical treatment in Siriraj Hospital between 1995 and 2007, were retrospectively reviewed. Plain radiographic findings were reviewed by an experienced musculoskeletal radiologist without knowledge of the clinical history or pathologic results. Specific attention on plain radiographic evaluations included site of tumor in long bone, total tumor volume, expansion of cortex, breaking of cortex, and presence of pathological fracture. Patients with grade III tumor were excluded due to malignant histology. Patients received treatments with amputation were also excluded due to no possibility of tumor recurrence. Only patients who received surgical treatments with wide excision or curettage with cement were included in the present study. Univariate analysis and Cox proportional hazard ratio was used to evaluate the influence of plain radiographic findings and histology grade on risk of tumor recurrence.
Seventy-four patients participated in this study and included 32 males (43%) and 42 (57%) females with a mean age of 35 years (range 17 to 84). The median follow-up time was 3.2 years. Forty-eight patients (65%) underwent curettage with cement or bone graft and 26 patients (35%) underwent wide excision. Sixty-three patients (85%) did not develop tumor recurrence while 11 patients (15%) developed local recurrent tumor. Those occurred only in patients who underwent curettage with cement or bone graft. None of the patients who underwent wide excision developed local recurrence. Median of time after operation to recurrence was 3.5 years (range, 0.5 to 10.3 years). Local recurrence occurred in the distal femur in five patients (45%), in the proximal tibia in five patients (45%), and in distal radius in one patient (9%). Risk of local recurrence of GCT was not statistically different in patients with any abnormal features of plain radiography as well as histology grade.
No radiographic findings and histological grade of GCT can predict tumor recurrence after curettage procedure. Compared with wide excision, risk of local recurrence in patients that received treatment with curettage was significantly higher. However the choice of treatment should be balanced between preserving maximal joint function and risks of tumor recurrence.
评估手术治疗后骨巨细胞瘤（GCT）局部复发与X线平片、病理分级及手术方式之间的关系。
对1995年至2007年间在诗里拉吉医院接受手术治疗且经病理证实为原发性长骨巨细胞瘤的患者进行回顾性研究。由一位经验丰富的肌肉骨骼放射科医生在不了解临床病史或病理结果的情况下对X线平片表现进行评估。X线平片评估的重点包括长骨肿瘤部位、肿瘤总体积、皮质膨胀、皮质破坏及病理性骨折情况。因组织学为恶性而排除III级肿瘤患者。因不存在肿瘤复发可能而排除接受截肢治疗的患者。本研究仅纳入接受广泛切除或刮除加骨水泥填充手术治疗的患者。采用单因素分析及Cox比例风险比评估X线平片表现及组织学分级对肿瘤复发风险的影响。
74例患者参与本研究，其中男性32例（43%），女性42例（57%），平均年龄35岁（17至84岁）。中位随访时间为3.2年。48例患者（65%）接受刮除加骨水泥填充或植骨治疗，26例患者（35%）接受广泛切除。63例患者（85%）未发生肿瘤复发，11例患者（15%）发生局部复发肿瘤。局部复发仅发生在接受刮除加骨水泥填充或植骨治疗的患者中。接受广泛切除的患者均未发生局部复发。术后复发时间的中位数为3.5年（0.5至10.3年）。5例患者（45%）在股骨远端发生局部复发，5例患者（45%）在胫骨近端发生局部复发，1例患者（9%）在桡骨远端发生局部复发。骨巨细胞瘤局部复发风险在具有任何X线平片异常特征及组织学分级的患者中无统计学差异。
骨巨细胞瘤的X线表现及组织学分级均不能预测刮除术后肿瘤复发。与广泛切除相比，接受刮除治疗的患者局部复发风险显著更高。然而，治疗选择应在保留最大关节功能与肿瘤复发风险之间取得平衡。
