外周骨骨巨细胞瘤刮除治疗后局部复发：GSF-GETO（法国肉瘤和骨肿瘤研究组）的回顾性研究。

Local recurrence after curettage treatment of giant cell tumors in peripheral bones: retrospective study by the GSF-GETO (French Sarcoma and Bone Tumor Study Groups).

机构信息

Clinique chirurgicale orthopédique et traumatologique, CHU Hôtel-Dieu, Nantes, France; Inserm UI 957, laboratoire de la résorption osseuse et des tumeurs osseuses primitives (LROP), faculté de médecine de Nantes, Nantes, France.

出版信息

Orthop Traumatol Surg Res. 2013 Oct;99(6 Suppl):S313-8. doi: 10.1016/j.otsr.2013.07.006. Epub 2013 Aug 23.

DOI:10.1016/j.otsr.2013.07.006

PMID:23978709

Abstract

BACKGROUND

Curettage is a well-established treatment modality for giant cell tumors of bone. The purpose of this retrospective study by the French Sarcoma and Bone Tumor Study Groups (GSF-GETO) was to analyze various tumor-specific and surgery-specific factors that could influence the rate of local recurrence.

PATIENTS AND METHOD

Data was collected from patients with giant cells tumors of the appendicular skeletal who were treated by intralesional curettage. The hazard ratio for tumor recurrence was calculated for the different variables collected and a multifactorial analysis carried out.

RESULTS

One hundred and ninety-three surgical procedures were included from nine centers. One hundred and seventy-one (89%) were primary tumors and 22 had been referred after one or more recurrences. The mean follow-up was 6 years and 11 months. The distal femur and proximal tibia were the most common locations: 42.5 and 34.2% of cases, respectively. The bone defect after curettage was filled in 176 cases (91.2%) and left empty in 16 cases. Local adjuvant treatment (phenol, alcohol, cryotherapy or combination treatment) was used in 39 cases (20.2%) and systemic adjuvant treatment used in 24 cases (calcitonin 11 and zoledronic acid 13). Local recurrence occurred in 71 cases (36.8%). Risk factors for local recurrence were an empty defect, a defect filled with autograft, and patients treated before 2005. Multivariate analysis showed that the only risk factors for local recurrence were a surgical procedure before 2005 (odds ratio 3.6 (95% CI: 1.2, 7.9) P=0.017) and a bone defect filled with autograft (odds ratio 3.9 [95% CI: 1.3, 11.6] P=0.013) CONCLUSION: Neither tumor-specific nor surgery-specific factors such as adjuvant treatment were found to be as risk factors for local recurrence after curettage of giant cell tumors in the appendicular skeleton. As recently reported, high-quality local curettage is probably the most effective technique to prevent local recurrence. The current study suggests that two factors associated with more recent management of these tumors in France, high-speed burring and centralization to skilled surgical teams, can improve the quality of curettage.

LEVEL OF EVIDENCE

4, retrospective cohort study.

摘要

背景

刮除术是治疗骨巨细胞瘤的一种成熟治疗方法。法国肉瘤和骨肿瘤研究组（GSF-GETO）进行这项回顾性研究的目的是分析可能影响局部复发率的各种肿瘤特异性和手术特异性因素。

患者和方法

收集了接受腔内刮除术治疗的四肢骨巨细胞瘤患者的数据。为不同收集的变量计算肿瘤复发的风险比，并进行多因素分析。

结果

从 9 个中心共纳入 193 例手术。其中 171 例（89%）为原发性肿瘤，22 例为一次或多次复发后转诊。平均随访时间为 6 年 11 个月。股骨远端和胫骨近端最常见，分别占 42.5%和 34.2%。176 例（91.2%）刮除后骨缺损填充，16 例骨缺损未填充。39 例（20.2%）采用局部辅助治疗（苯酚、酒精、冷冻疗法或联合治疗），24 例（降钙素 11 例，唑来膦酸 13 例）采用全身辅助治疗。71 例（36.8%）发生局部复发。局部复发的危险因素为空骨缺损、用自体骨填充的骨缺损和 2005 年前治疗的患者。多因素分析显示，局部复发的唯一危险因素是 2005 年前的手术（优势比 3.6（95%CI：1.2，7.9）P=0.017）和用自体骨填充的骨缺损（优势比 3.9（95%CI：1.3，11.6）P=0.013）。