Department of Orthopedics, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands.
Bone Joint J. 2019 Mar;101-B(3):272-280. doi: 10.1302/0301-620X.101B3.BJJ-2018-0804.R1.
The aim of this study was to evaluate health-related quality of life (HRQoL) and joint function in tenosynovial giant cell tumour (TGCT) patients before and after surgical treatment.
This prospective cohort study run in two Dutch referral centres assessed patient-reported outcome measures (PROMs; 36-Item Short-Form Health Survey (SF-36), visual analogue scale (VAS) for pain, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)) in 359 consecutive patients with localized- and diffuse-type TGCT of large joints. Patients with recurrent disease (n = 121) and a wait-and-see policy (n = 32) were excluded. Collected data were analyzed at specified time intervals preoperatively (baseline) and/or postoperatively up to five years.
A total of 206 TGCT patients, 108 localized- and 98 diffuse-type, were analyzed. Median age at diagnosis of localized- and diffuse-type was 41 years (interquartile range (IQR) 29 to 49) and 37 years (IQR 27 to 47), respectively. SF-36 analyses showed statistically significant and clinically relevant deteriorated preoperative and immediate postoperative scores compared with general Dutch population means, depending on subscale and TGCT subtype. After three to six months of follow-up, these scores improved to general population means and continued to be fairly stable over the following years. VAS scores, for both subtypes, showed no statistically significant or clinically relevant differences pre- or postoperatively. In diffuse-type patients, the improvement in median WOMAC score was statistically significant and clinically relevant preoperatively versus six to 24 months postoperatively, and remained up to five years' follow-up.
Patients with TGCT report a better HRQoL and joint function after surgery. Pain scores, which vary hugely between patients and in patients over time, did not improve. A disease-specific PROM would help to decipher the impact of TGCT on patients' daily life and functioning in more detail. Cite this article: Bone Joint J 2019;101-B:272-280.
本研究旨在评估腱鞘巨细胞瘤（TGCT）患者手术前后的健康相关生活质量（HRQoL）和关节功能。
本前瞻性队列研究在荷兰的两个转诊中心开展，共纳入 359 例局限性和弥漫性大关节 TGCT 患者，评估了患者报告的结局测量（PROMs），包括 36 项简短健康调查问卷（SF-36）、疼痛视觉模拟量表（VAS）和西部安大略省和麦克马斯特大学骨关节炎指数（WOMAC）。排除复发性疾病患者（n=121）和观察等待患者（n=32）。在术前（基线）和术后五年内的特定时间间隔采集数据进行分析。
共纳入 206 例 TGCT 患者，其中局限性 108 例，弥漫性 98 例。局限性和弥漫性 TGCT 的诊断中位年龄分别为 41 岁（四分位距 29 至 49）和 37 岁（四分位距 27 至 47）。SF-36 分析显示，与一般荷兰人群平均值相比，局限性和弥漫性 TGCT 患者术前和术后即刻的评分均显著下降且具有临床意义，这取决于亚量表和 TGCT 亚型。术后 3 至 6 个月时，这些评分恢复至一般人群平均值，且在随后的几年中保持相对稳定。两种亚型的 VAS 评分术前和术后均无统计学意义或临床意义的差异。在弥漫性患者中，术前与术后 6 至 24 个月的 WOMAC 评分改善具有统计学意义且具有临床意义，且在 5 年随访时仍保持改善。
TGCT 患者术后报告 HRQoL 和关节功能得到改善。疼痛评分在患者之间和患者随时间变化差异较大，并无改善。一种疾病特异性的 PROM 将有助于更详细地了解 TGCT 对患者日常生活和功能的影响。
Bone Joint J. 2019;101-B:272-280.
