Jamshidi Khodamorad, Karimi Amin, Mirzaei Alireza
Bone and Joint Reconstruction Research Center, Shafa Ortopaedic Hospital, Iran University of Medical Science, Tehran, Iran.
Research performed at Baharestan Square, Shafa Orthopedic Hospital, Tehran, Iran.
Arch Bone Jt Surg. 2019 Nov;7(6):538-544.
Giant cell tumor of bone (GCTB) is a locally aggressive lesion with an unpredictable behavior. Herein, the aim of this study was to evaluate the epidemiological characteristics, as well as clinical and functional outcomes of GCTB in a relatively large series of patients.
Patients with the diagnosis of GCTB were included in this retrospective study. Whenever the preservation of the articular surface was possible, surgical options included extended curettage; otherwise, wide resection was implemented. In case of extended curettage, the cavity was filled with cement or bone graft. In addition, the functional and oncologic outcomes of these surgical strategies were compared. The functional outcome of the patients was assessed using the Musculoskeletal Tumor Society (MSTS) scoring system.
A total of 120 GCTB patients, including 55 males (45.8%) and 65 females (54.2%), were evaluated. The three involved locations with highest frequency included distal femur (26%), distal radius (22%), and proximal tibia (19%). At a mean follow-up of 125.5±49.2 months, two pulmonary metastases (1.6%) and 12 (10%) local recurrences were observed. In addition, 6 out of 12 (50%) local recurrences occurred in distal radius (). The recurrence rate was significantly higher in extended curettage than in wide resection (), and the same pattern was observed for allograft, compared to cement filling (). The mean MSTS scores for extended curettage and wide resection were 94.7 and 89.1, respectively (). Furthermore, the mean MSTS scores for bone graft filling and cement augmentation were obtained as 96 and 93.1, respectively ().
Based on the findings, wide resection of GCTB was associated with superior oncologic outcome, as well as inferior functional outcome. In extended curettage, cement augmentation resulted in superior oncologic outcome when compared with allograft filling.
骨巨细胞瘤（GCTB）是一种具有不可预测行为的局部侵袭性病变。在此，本研究的目的是评估相对大量患者中GCTB的流行病学特征以及临床和功能结局。
本回顾性研究纳入了诊断为GCTB的患者。只要有可能保留关节面，手术选择包括扩大刮除术；否则，实施广泛切除术。在扩大刮除术的情况下，腔隙用骨水泥或骨移植填充。此外，比较了这些手术策略的功能和肿瘤学结局。使用肌肉骨骼肿瘤学会（MSTS）评分系统评估患者的功能结局。
共评估了120例GCTB患者，其中男性55例（45.8%），女性65例（54.2%）。三个受累频率最高的部位包括股骨远端（26%）、桡骨远端（22%）和胫骨近端（19%）。平均随访125.5±49.2个月，观察到2例肺转移（1.6%）和12例（10%）局部复发。此外，12例局部复发中有6例（50%）发生在桡骨远端（）。扩大刮除术的复发率显著高于广泛切除术（），与骨水泥填充相比，同种异体骨移植的复发率也呈现相同模式（）。扩大刮除术和广泛切除术的平均MSTS评分分别为94.7和89.1（）。此外，骨移植填充和骨水泥增强的平均MSTS评分分别为96和93.1（）。
基于这些发现，GCTB的广泛切除术与较好的肿瘤学结局相关，但功能结局较差。在扩大刮除术中，与同种异体骨移植填充相比，骨水泥增强导致更好的肿瘤学结局。
