Department of Internal Medicine, Division of Pulmonary, Allergy and Sleep Medicine, HELIOS Clinic Wuppertal, Witten/Herdecke University, Witten, Germany.
Adv Exp Med Biol. 2019;1176:1-17. doi: 10.1007/5584_2019_372.
Giant cell tumors of the bone are rare, usually benign, tumors consisting of large, multinucleated bone cells. Remarkably, these tumors are characterized by aggressive growth. They tend to recur frequently and, in rare cases, metastasize to the lungs. Previous studies tried to identify risk factors for lung metastasis by giant cell bone tumors. Those studies reported different results due to a small number of patients. Therefore, a particularly high risk associated with this type of bone tumor prompted this systematic review and meta-analysis to identify risk factors for the development of lung metastases. The risk factors for lung metastasis by giant cell bone tumors searched for in this study were gender, age, lung metastasis and recurrence period, follow-up time, primary or recurrent tumor, Campanacci grading, tumor localization, disease course, treatment of primary and recurrent tumors, and pulmonary metastases treated by surgery, radiation, and chemotherapy. This meta-analysis identified the features outlined above by comparing the groups of patients with giant cell bone tumors and lung metastases with the control group consisting of patients without lung metastases. The search for suitable studies revealed 63 publications with a total of 4,295 patients with giant cell bone tumors. Of these, 247 (5.8%; 95% confidence interval (95%CI) 5.1-6.5%) patients had lung metastases. Further, the risk factors for lung metastases were the following: recurrence (p < 0.0001), lung metastasis time (p < 0.0001), Campanacci grade II (p = 0.028) and grade III (p = 0.006), localization in the lower limbs (p = 0.0007), curettage (p = 0.0005), and local irradiation of the primary tumor (p = 0.008). All studies showed a high-risk bias due to the absence of blinding of the participants, personnel, and outcome assessment. Special attention should be paid to tumor recurrence in the long follow-up time, since more advanced giant cell bone tumors, particularly in lower extremities, tend to reoccur and metastasize to the lung. Surgical treatment and local irradiation should be performed thoughtfully, with extended follow-up periods.
骨巨细胞瘤是一种罕见的良性肿瘤，由体积较大、多核的骨细胞组成。值得注意的是，这些肿瘤具有侵袭性生长的特点。它们往往频繁复发，在极少数情况下，还会转移到肺部。之前的研究试图通过骨巨细胞瘤来确定肺转移的危险因素。由于患者数量较少，这些研究报告的结果也各不相同。因此，鉴于这种类型的骨肿瘤存在较高的风险，我们进行了这项系统回顾和荟萃分析，以确定肺转移的危险因素。本研究中搜索的骨巨细胞瘤发生肺转移的危险因素包括性别、年龄、肺转移和复发时间、随访时间、原发或复发肿瘤、坎帕纳奇分级、肿瘤定位、病程、原发和复发肿瘤的治疗以及通过手术、放疗和化疗治疗的肺转移。通过比较有骨巨细胞瘤和肺转移的患者组与无肺转移的对照组，本荟萃分析确定了上述特征。适合的研究搜索发现，共有 63 篇出版物，涉及 4295 例骨巨细胞瘤患者。其中，247 例（5.8%；95%置信区间（95%CI）为 5.1-6.5%）患者发生了肺转移。此外，肺转移的危险因素包括：复发（p<0.0001）、肺转移时间（p<0.0001）、坎帕纳奇 II 级（p=0.028）和 III 级（p=0.006）、下肢定位（p=0.0007）、刮除术（p=0.0005）和原发性肿瘤的局部放疗（p=0.008）。所有研究均因参与者、人员和结果评估的缺乏盲法而显示出高风险偏倚。应特别注意长期随访中肿瘤的复发，因为更晚期的骨巨细胞瘤，特别是下肢的肿瘤，更易复发并转移到肺部。应慎重考虑手术治疗和局部放疗，并进行长期随访。
