骶骨巨细胞瘤——一项关于26例患者经病灶内切除术后中期结果的全国性研究。
Giant cell tumors of the sacrum--a nationwide study on midterm results in 26 patients after intralesional excision.
作者信息
van der Heijden L, van de Sande M A J, van der Geest I C M, Schreuder H W B, van Royen B J, Jutte P C, Bramer J A M, Öner F C, van Noort-Suijdendorp A P, Kroon H M, Dijkstra P D S
机构信息
Department of Orthopedic Surgery, Leiden University Medical Center (LUMC), Postzone J11-70, PO Box 9600, 2300 RC, Leiden, The Netherlands,
出版信息
Eur Spine J. 2014 Sep;23(9):1949-62. doi: 10.1007/s00586-014-3263-5. Epub 2014 Mar 11.
PURPOSE
Evaluation of recurrences, complications and function at mid-term follow-up after curettage for sacral giant cell tumor (GCT).
METHODS
We retrospectively studied all 26 patients treated for sacral GCT in the Netherlands (from 1990 to 2010). Median follow-up was 98 (6-229) months. All patients underwent intralesional excision, 21 with local adjuvants, 5 radiotherapy, 3 IFN-α, 1 bisphosphonates. Functional outcome was assessed using Musculoskeletal Tumor Society (MSTS) score. Statistics were performed with Kaplan-Meier, Cox regression, log rank and Mann-Whitney U.
RESULTS
Recurrence rate was 14/26 after median 13 (3-139) months and was highest after isolated curettage (4/5). Soft tissue masses >10 cm increased recurrence risk (HR = 3.3, 95 % CI = 0.81-13, p = 0.09). Complications were reported in 12/26 patients. MSTS was superior in patients without complications (27 vs. 21; p = 0.024).
CONCLUSION
Recurrence rate for sacral GCT was highest after isolated curettage, indicating that (local) adjuvant treatment is desired to obtain immediate local control. Complications were common and impaired function.
目的
评估骶骨巨细胞瘤刮除术后中期随访时的复发情况、并发症及功能。
方法
我们回顾性研究了荷兰1990年至2010年间接受治疗的所有26例骶骨巨细胞瘤患者。中位随访时间为98（6 - 229）个月。所有患者均接受病灶内切除，21例使用局部辅助治疗，5例接受放疗，3例使用α干扰素，1例使用双膦酸盐。使用肌肉骨骼肿瘤学会（MSTS）评分评估功能结果。采用Kaplan - Meier法、Cox回归、对数秩检验和Mann - Whitney U检验进行统计学分析。
结果
中位13（3 - 139）个月后复发率为14/26，单纯刮除术后复发率最高（4/5）。软组织肿块>10 cm会增加复发风险（HR = 3.3，95% CI = 0.81 - 13，p = 0.09）。26例患者中有12例报告了并发症。无并发症患者的MSTS评分更高（27比21；p = 0.024）。
结论
单纯刮除术后骶骨巨细胞瘤的复发率最高，这表明需要（局部）辅助治疗以实现即刻局部控制。并发症常见且影响功能。
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