Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Centre-University of Freiburg, Freiburg, Germany.
Department of Orthopaedic Surgery and Traumatology, St. Elisabeth Hospital, Ravensburg, Germany.
PLoS One. 2021 Dec 2;16(12):e0260795. doi: 10.1371/journal.pone.0260795. eCollection 2021.
The tenosynovial giant cell tumor (TGCT) is a usually benign lesion which arises from the synovium. It affects joints, tendon sheaths and bursae. The clinical course is often unpredictable, and local recurrences frequently occur. The aim of this study was to describe different treatment options, surgical complications, and to develop a follow-up regime based on a systematic literature review and meta-analysis of foot and ankle lesions.
1284 studies published between 01/1966 and 06/2021 were identified. 25 met the inclusion criteria, with a total of 382 patients. Of these, 212 patients had a diffuse (dTGCT) and 170 a localized (lTGCT) TGCT. Patients with a dTGCT had a mean age of 36.6±8.2 years, and 55% were female. The overall complication rate was 24% in dTGCT, irrespective of the therapeutic procedure; the mean follow-up was 37.9±27.4 months with a recurrence rate of 21%, and recurrences occurred between 3 and 144 months, the vast majority (86%) within the first 5 years following intervention. Patients with a lTGCT had a mean age of 31.2±5.7 years, and 53% were female. Complications occurred in 12%. The mean follow-up was 51.1±24.6 months, the recurrence rate was 7%, and recurrence occurred between 1 and 244 months after intervention.
Diffuse TGCTs of the foot and ankle region have a remarkable recurrence rate irrespective of therapeutic procedures, and most lesions reoccurred within 5, with more than half of these in the first 2 years. The lTGCTs are well treatable lesions, with a low recurrence and a moderate complication rate. Based on these findings, we propose a follow-up regime for the dTGCT including a clinical survey and MR imaging 3 months after surgical intervention (baseline), followed by twice-yearly intervals for the first 2 years, yearly intervals up to the fifth year, and further individual follow-up due to the fact that recurrences can even occur for years later. For the lTGCT a clinical survey and MRT is proposed after 3-6 months after intervention (baseline), followed by annual clinical examination for 3 years, and in case of symptoms MR-imaging. Larger prospective multi-center studies are necessary to confirm these results and recommendations.
腱鞘巨细胞瘤（TGCT）是一种通常良性的病变，来源于滑膜。它影响关节、腱鞘和滑囊。临床过程往往不可预测，局部复发频繁发生。本研究旨在描述不同的治疗选择、手术并发症，并基于对足部和踝关节病变的系统文献回顾和荟萃分析制定随访方案。
1966 年 1 月至 2021 年 6 月期间共检索到 1284 篇文献，其中 25 篇符合纳入标准，共 382 例患者。其中，212 例为弥漫性（dTGCT），170 例为局限性（lTGCT）TGCT。dTGCT 患者的平均年龄为 36.6±8.2 岁，55%为女性。dTGCT 患者的总体并发症发生率为 24%，与治疗方法无关；平均随访时间为 37.9±27.4 个月，复发率为 21%，复发发生在 3 至 144 个月之间，绝大多数（86%）在干预后 5 年内发生。lTGCT 患者的平均年龄为 31.2±5.7 岁，53%为女性。发生并发症 12%。平均随访时间为 51.1±24.6 个月，复发率为 7%，复发发生在干预后 1 至 244 个月之间。
足部和踝关节弥漫性 TGCT 无论治疗方法如何，复发率都很高，大多数病变在 5 年内复发，其中一半以上在最初的 2 年内复发。局限性 TGCT 是一种可治疗的病变，复发率低，并发症发生率中等。基于这些发现，我们提出了一种针对 dTGCT 的随访方案，包括手术干预后 3 个月（基线）进行临床检查和磁共振成像（MRI），然后在前 2 年内每 6 个月进行一次，在第 5 年内每年进行一次，然后根据需要进行个体化随访，因为即使在数年之后也可能会复发。对于 lTGCT，建议在干预后 3-6 个月（基线）进行临床检查和 MRI，然后在前 3 年内每年进行临床检查，如果有症状则进行 MRI 检查。需要更大规模的前瞻性多中心研究来证实这些结果和建议。
