Howard Emma L, Gregory Jonathan, Tsoi Kim, Evans Scott, Flanagan Adrienne, Cool Paul
Orthopaedic Oncology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, GBR.
Orthopaedic Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, GBR.
Cureus. 2020 Jul 13;12(7):e9164. doi: 10.7759/cureus.9164.
This study evaluates the relationship between pregnancy, comorbid conditions and giant cell tumour of bone. Furthermore, it examines if pregnancy and comorbid conditions affect the outcome following treatment for this tumour. A multi-centre retrospective review was conducted of consecutive patients with a confirmed histological diagnosis of giant cell tumour of bone between June 2012 and May 2017. A total of 195 patients were identified from two centres. Of these, 168 patients were treated with curative intent and had more than six months follow-up. Data were collected on pregnancy status, comorbid conditions, site of disease, surgical management and local recurrence rates. Statistical analysis included the Fisher exact test and Kaplan-Meier survival analysis. There were 72 females of childbearing age, of which 15 (21%) were currently pregnant or had been pregnant within the last six months. The pregnancy rate is higher than the highest reported pregnancy rate over the last 10 years (8.4%; Fisher test, p = 0.033). Women were more likely to have a comorbid condition than men (Fisher test, p < 0.002) and had a higher rate of autoimmune disease than the normal population (p = 0.015). Men were older than women (Wilcoxon test, p = 0.046) and had less risk of local recurrence (logrank test, p = 0.014). Pregnancy or comorbid conditions did not increase the local recurrence rate. Predictors for local recurrence included location in the distal radius (logrank test, p < 0.001), intralesional treatment (logrank test, p = 0.008) and age less than 40 (logrank test, p = 0.043). In conclusion, giant cell tumour of bone is more common in pregnant females and patients with immune disease. Comorbidities and pregnancy do not affect the local recurrence rate. Male patients over 40 years of age have a lower risk of local recurrence, and patients with disease in the distal radius have a high risk of recurrence.
本研究评估妊娠、合并症与骨巨细胞瘤之间的关系。此外，还研究妊娠和合并症是否会影响该肿瘤治疗后的结局。对2012年6月至2017年5月期间经组织学确诊为骨巨细胞瘤的连续患者进行了多中心回顾性研究。从两个中心共确定了195例患者。其中，168例患者接受了根治性治疗，且随访时间超过6个月。收集了有关妊娠状态、合并症、疾病部位、手术治疗和局部复发率的数据。统计分析包括Fisher精确检验和Kaplan-Meier生存分析。有72名育龄女性，其中15名（21%）目前正在怀孕或在过去6个月内怀孕。该妊娠率高于过去10年报告的最高妊娠率（8.4%；Fisher检验，p = 0.033）。女性比男性更易合并其他疾病（Fisher检验，p < 0.002），且自身免疫性疾病发生率高于正常人群（p = 0.015）。男性比女性年龄大（Wilcoxon检验，p = 0.046），局部复发风险更低（对数秩检验，p = 0.014）。妊娠或合并症并未增加局部复发率。局部复发的预测因素包括位于桡骨远端（对数秩检验，p < 0.001）、病灶内治疗（对数秩检验，p = 0.008）和年龄小于40岁（对数秩检验，p = 0.043）。总之，骨巨细胞瘤在妊娠女性和免疫疾病患者中更为常见。合并症和妊娠不影响局部复发率。40岁以上男性患者局部复发风险较低，而桡骨远端患病的患者复发风险较高。
