骨巨细胞瘤的治疗与复发——来自一个发展中国家的回顾性队列研究
Treatment and recurrence of giant cell tumors of bone - A retrospective cohort from a developing country.
作者信息
Hasan Obada, Ali Moiz, Mustafa Mohammad, Ali Arif, Umer Masood
机构信息
Resident Section of Orthopaedics, Department of Surgery, Aga Khan University Hospital Karachi, Pakistan.
Resident Department of Surgery Abbasi Shaheed Hospital, Karachi, Pakistan.
出版信息
Ann Med Surg (Lond). 2019 Oct 15;48:29-34. doi: 10.1016/j.amsu.2019.10.010. eCollection 2019 Dec.
INTRODUCTION
GCT is a benign primary bone tumor which is known to cause local recurrence as well as distant metastases. The standard care of treatment of GCT in our institution is the extended intralesional curettage followed by the use bone cement and either phenol or alcohol as adjunct therapy. This offers preservation of joint closest to tumor and decreased risk of recurrence compared to curettage alone. Therefore, the objective of this study was to assess the recurrence of GCT of the bone and time of recurrence-free survival after primary surgery (curettage with adjunct therapy) and determine the influence of factors like site of tumor involvement and demographic factors on the risk of recurrence.
METHODS
Non-funded, non-commercial single group retrospective cohort study was conducted at a tertiary care university hospital. Total of 44 patients treated for primary GCT of the bone between 1995 and 2015 at our institution were included. Medical record files were reviewed for demographic characteristics, intra-operative findings and post-operative follow-up. Risk factors for recurrence and mean recurrence free survival was calculated using appropriate statistical analysis.
RESULTS
Proximal tibia was the most commonly involved bone followed by distal femur, while intralesional curettage with either phenol or alcohol as adjunct was the most common primary treatment. Mean follow-up period for all patients was 52.1 ± 43.9 months. Out of the 46 tumors operated primarily at our institution, recurrence developed in eight (17.4%) cases. Extra-compartmental spread of tumor and tumor grade were identified to have a significant association with recurrence (P = 0.013 and 0.043 respectively). Estimated recurrence free survival at 2 and 5 - year interval was 0.85 and 0.83 respectively.
CONCLUSION
Extra-compartmental extension of tumor and a higher-grade lesion is significantly associated with development of recurrence in cases of GCT of bone.
引言
骨巨细胞瘤（GCT）是一种原发性良性骨肿瘤，已知会导致局部复发以及远处转移。在我们机构，GCT的标准治疗方法是扩大病灶内刮除术，随后使用骨水泥，并以苯酚或酒精作为辅助治疗。与单纯刮除术相比，这能保留最接近肿瘤的关节，并降低复发风险。因此，本研究的目的是评估骨GCT的复发情况以及初次手术后（刮除术加辅助治疗）的无复发生存时间，并确定肿瘤累及部位和人口统计学因素等因素对复发风险的影响。
方法
在一家三级医疗大学医院进行了一项非资助、非商业的单组回顾性队列研究。纳入了1995年至2015年间在我们机构接受原发性骨GCT治疗的44例患者。查阅病历档案以获取人口统计学特征、术中发现和术后随访情况。使用适当的统计分析计算复发的危险因素和平均无复发生存期。
结果
胫骨近端是最常受累的骨骼，其次是股骨远端，而以苯酚或酒精作为辅助的病灶内刮除术是最常见的主要治疗方法。所有患者的平均随访期为52.1±43.9个月。在我们机构主要接受手术的46个肿瘤中，有8例（17.4%）出现复发。肿瘤的间室外扩散和肿瘤分级被确定与复发有显著关联（分别为P = 0.013和0.043）。2年和5年间隔的估计无复发生存率分别为0.85和0.83。
结论
骨GCT病例中，肿瘤的间室外扩展和较高分级的病变与复发的发生显著相关。
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