Department of Orthopedic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan.
J Orthop Surg (Hong Kong). 2020 Jan-Apr;28(2):2309499020929786. doi: 10.1177/2309499020929786.
Giant cell tumor of bone (GCTB) is a local aggressive bone tumor, histologically classified as intermediate malignancy. Recently, the RANKL inhibitor, denosumab, was developed as a novel and effective treatment option for GCTB. Since the risk of preoperative use of denosumab with curettage had been previously reported, this study aimed to investigate the relationship between recurrences and clinicopathological features associated with adjuvant denosumab treatment in GCTB.
A total of 87 GCTB cases were treated at our institution. We reviewed 66 patients with conventional-type GCTB occurring in the extremities and analyzed 78 surgical treatments, including curettages and resections, with clinicopathological features and denosumab treatment.
GCTB lesions, including 66 primary and 12 recurring, underwent surgical treatment like curettage and resection. Recurrence-free survivals in 78 GCTB surgeries were 78.7% in 3 years and 71.9% in 5 years. In the resected cases of GCTBs, there was no recurrence either with or without denosumab. In curettage cases, 3-year recurrence-free survivals were 0.0% ( = 3) in preoperative treatment of denosumab, 66.7% ( = 6) in postoperative treatment, and 76.6% ( = 43) in no treatment. Interestingly, three preoperative treatment cases demonstrated low MIB-1 index despite 100% recurrence. The other clinicopathological factors did not contribute much to the risk of recurrence in curettage cases.
Our findings revealed the use of denosumab in GCTB, prior to curettage, to possibly increase the risk of local recurrence. Together with previous reports, our finding might provide information for beneficial treatment of GCTB.
骨巨细胞瘤（GCTB）是一种局部侵袭性骨肿瘤，组织学上归类为中度恶性肿瘤。最近，RANKL 抑制剂地舒单抗被开发为 GCTB 的一种新的有效治疗选择。由于术前使用地舒单抗联合刮除术的风险已有报道，本研究旨在探讨 GCTB 中与辅助地舒单抗治疗相关的复发和临床病理特征之间的关系。
本研究共纳入 87 例在我院治疗的 GCTB 患者。我们回顾了 66 例发生在四肢的常规型 GCTB 患者的资料，并分析了包括刮除术和切除术在内的 78 种手术治疗方法，包括临床病理特征和地舒单抗治疗。
GCTB 病变，包括 66 例原发性病变和 12 例复发性病变，采用刮除术和切除术进行手术治疗。78 例 GCTB 手术的无复发生存率在 3 年内为 78.7%，在 5 年内为 71.9%。在 GCTB 的切除病例中，无论是否使用地舒单抗，均无复发。在刮除病例中，术前地舒单抗治疗的 3 年无复发生存率为 0.0%（=3），术后为 66.7%（=6），未治疗为 76.6%（=43）。有趣的是，尽管 100%的病例均复发，但有 3 例术前治疗的病例 MIB-1 指数较低。其他临床病理因素对地舒单抗治疗病例的复发风险影响不大。
我们的研究结果表明，在刮除术之前使用地舒单抗治疗 GCTB 可能会增加局部复发的风险。结合以往的报告，我们的发现可能为 GCTB 的有益治疗提供信息。
