Lans Jonathan, Oflazoglu Kamil, Lee Hang, Harness Neil G, Castelein René M, Chen Neal C, Lozano Calderón Santiago A
Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
J Hand Surg Am. 2020 Aug;45(8):738-745. doi: 10.1016/j.jhsa.2020.04.020. Epub 2020 Jun 29.
Giant cell tumors (GCT) of the distal radius are thought to be more aggressive than in other locations. Therefore, the aim of this study was to investigate factors associated with recurrence of GCTs in the upper extremity.
We retrospectively identified 82 patients who underwent primary surgical treatment for an upper extremity GCT. Tumors were located in the radius (n = 47), humerus (n = 17), ulna (n = 9), and hand (n = 9). Treatment consisted of either wide resection or amputation or intralesional resection with or without adjuvants. A multivariable logistic regression was performed including tumor grade, type of surgery, and tumor location, from which the percentage of contribution to the model of each variable was calculated.
The recurrence rate after intralesional resection was 48%; after wide resection or amputation, it was 12%. Two patients developed a pulmonary metastasis (2.4%). In multivariable analysis, intralesional resection was independently associated with recurrence. Intralesional resection had a 77% contribution to predict recurrence and the distal radius location had a 16% contribution in the predictive model.
As expected, intralesional resection was the strongest independent predictor of recurrence after surgical treatment for GCT. The distal radius location contributed to the prediction of giant cell tumor recurrence to a lesser extent.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.
桡骨远端骨巨细胞瘤（GCT）被认为比其他部位的更具侵袭性。因此，本研究的目的是调查与上肢GCT复发相关的因素。
我们回顾性确定了82例接受上肢GCT初次手术治疗的患者。肿瘤位于桡骨（n = 47）、肱骨（n = 17）、尺骨（n = 9）和手部（n = 9）。治疗包括广泛切除或截肢或病灶内切除（有或无辅助治疗）。进行多变量逻辑回归分析，包括肿瘤分级、手术类型和肿瘤位置，并计算每个变量对模型的贡献百分比。
病灶内切除后的复发率为48%；广泛切除或截肢后的复发率为12%。两名患者发生肺转移（2.4%）。在多变量分析中，病灶内切除与复发独立相关。病灶内切除对预测复发的贡献为77%，桡骨远端位置在预测模型中的贡献为16%。
正如预期的那样，病灶内切除是GCT手术治疗后复发的最强独立预测因素。桡骨远端位置对骨巨细胞瘤复发预测的贡献较小。
研究类型/证据水平：预后性IV级。
