Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara-city, Nara, 634-8521, Japan.
Orthopaedic Service, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
J Orthop Surg Res. 2020 Nov 7;15(1):510. doi: 10.1186/s13018-020-02038-1.
The outcomes of patients with lung metastases from giant cell tumor of bone (GCTB) vary from spontaneous regression to uncontrolled growth. To investigate whether observation is an appropriate first-line management approach for patients with lung metastases from GCTB, we evaluated the outcomes of patients who were initially managed by observation.
We retrospectively reviewed the data of 22 patients with lung metastases from histologically confirmed GCTB who received observation as a first-line treatment approach. The median follow-up period was 116 months.
Disease progression occurred in 12 patients (54.5%). The median interval between the discovery of lung metastases and progression was 8 months. Eight patients underwent metastasectomy following initial observation. The median interval between the discovery of lung metastases and treatment by metastasectomy was 13.5 months. None of the patients experienced spontaneous regression. Of the 22 patients, 36.4% needed a metastasectomy, and 9.1% required denosumab treatment during the course of the follow-up period. Disease progression occurred in 45.5% of the 11 patients with lung nodules ≤ 5 mm, while all five of the patients with lung nodules > 5 mm experienced disease progression. Progression-free survival was significantly worse in the group with lung nodules > 5 mm compared to the group with lung nodules ≤ 5 mm (p = 0.022).
Observation is a safe first-line method of managing patients with lung metastases from GCTB. According to radiological imaging, approximately half of the patients progressed, and approximately half required a metastasectomy or denosumab treatment. However, patients with lung nodules > 5 mm should receive careful observation because of the high rate of disease progression in this group.
患有骨巨细胞瘤（GCTB）肺转移的患者的结局从自发消退到不受控制的生长不等。为了研究观察是否是 GCTB 肺转移患者的一线治疗方法，我们评估了初始接受观察治疗的患者的结局。
我们回顾性分析了 22 例经组织学证实的 GCTB 肺转移患者的资料，这些患者接受了观察作为一线治疗方法。中位随访时间为 116 个月。
12 例患者（54.5%）发生疾病进展。从发现肺转移到进展的中位间隔时间为 8 个月。8 例患者在初始观察后接受了转移灶切除术。从发现肺转移到接受转移灶切除术的中位间隔时间为 13.5 个月。没有患者出现自发性消退。在 22 例患者中，有 36.4%需要进行转移灶切除术，9.1%需要在随访期间使用地舒单抗治疗。肺结节≤5mm 的 11 例患者中有 45.5%发生疾病进展，而所有 5 例肺结节>5mm 的患者均发生疾病进展。肺结节>5mm 的患者无进展生存率明显差于肺结节≤5mm 的患者（p=0.022）。
观察是 GCTB 肺转移患者安全的一线治疗方法。根据影像学检查，约有一半的患者进展，约有一半的患者需要进行转移灶切除术或地舒单抗治疗。然而，由于这组患者疾病进展率较高，肺结节>5mm 的患者应接受密切观察。
