巨细胞瘤合并继发性动脉瘤样骨囊肿更易发生术后复发：256 例回顾性研究。
Giant cell tumors combined with secondary aneurysmal bone cysts are more likely to develop postoperative recurrence: A retrospective study of 256 cases.
机构信息
Department of Orthopaedics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.
出版信息
J Surg Oncol. 2019 Sep;120(3):359-365. doi: 10.1002/jso.25588. Epub 2019 Jun 20.
PURPOSE
The epidemiology and clinicopathology of aneurysmal bone cysts (ABCs) secondary to giant cell tumors of bone (GCTBs) have been well documented in the previous literature. However, reports on whether secondary ABCs could affect the postoperative recurrence of GCTBs are rare. This study analyzed the effects of secondary ABCs and other relevant clinical factors on the postoperative recurrence of GCTBs of the extremities.
METHODS
We retrospectively analyzed 256 cases of GCTBs of the extremities that were treated surgically at our institution. Among them, there were 60 patients diagnosed with GCTBs combined with secondary ABCs and 196 patients diagnosed with simple GCTBs. Intralesional curettage and tumor resection were performed in 136 and 120 cases, respectively. Univariate analysis, Kaplan-Meier survival analysis, and multivariate regression analysis were used to assess the factors for postoperative recurrence. The follow-up period was at least 24 months.
RESULTS
The total postoperative recurrence rate was 32%. The recurrence rate in the secondary ABCs group was significantly higher than that in the simple GCTBs group (53.3% vs 25.5%, P < 0.05). Curettage was associated with a higher recurrence rate than tumor resection (42.5% vs 20%, P < 0.05). Kaplan-Meier survival analysis showed that patients with GCTBs combined with secondary ABCs and who were treated by intralesional curettage had a decreased disease-free survival rate. The hazard ratio was 2.18 (95% confidence interval [CI], 1.15-4.13) for the group of GCTB combined with ABCs ( P = 0.01) and 1.97 (95% CI, 1.22-7.50) for the curettage group ( P = 0.01), respectively. Multivariate regression analysis revealed that the presence of secondary ABCs and curettage were independent factors for recurrence of GCTBs.
CONCLUSION
According to the results of this study, the presence of secondary ABCs is a potential risk factor for postoperative relapse of GCTBs.
目的
动脉瘤样骨囊肿（ABC）继发于骨巨细胞瘤（GCTB）的流行病学和临床病理学已在前人的文献中得到充分阐述。然而，关于继发性 ABC 是否会影响 GCTB 术后复发的报道却很少。本研究分析了继发性 ABC 和其他相关临床因素对四肢 GCTB 术后复发的影响。
方法
我们回顾性分析了在我院接受手术治疗的 256 例四肢 GCTB 患者。其中，60 例诊断为 GCTB 合并继发性 ABC，196 例诊断为单纯 GCTB。分别对 136 例和 120 例患者进行了病灶内刮除和肿瘤切除术。采用单因素分析、Kaplan-Meier 生存分析和多因素回归分析评估术后复发的相关因素。随访时间至少 24 个月。
结果
总的术后复发率为 32%。继发性 ABC 组的复发率明显高于单纯 GCTB 组（53.3%比 25.5%，P<0.05）。病灶内刮除术的复发率高于肿瘤切除术（42.5%比 20%，P<0.05）。Kaplan-Meier 生存分析显示，患有 GCTB 合并继发性 ABC 并接受病灶内刮除术治疗的患者，无病生存率降低。GCTB 合并 ABC 组的危险比为 2.18（95%置信区间[CI]，1.15-4.13）（P=0.01），刮除术组的危险比为 1.97（95% CI，1.22-7.50）（P=0.01）。多因素回归分析显示，继发性 ABC 的存在和刮除术是 GCTB 复发的独立因素。
结论
根据本研究结果，继发性 ABC 的存在是 GCTB 术后复发的潜在危险因素。
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