AlYami Ali H, Nazer Abdulaziz, Bashawieh Hussam H, Dabroom Albara A, Saem Aldahar Majd, AlYami AlWaleed A, AlMaeen Bandar N
Department of Surgery, Ministry of the National Guard - Health Affairs, Jeddah, SAU.
Department of Surgery, King Abdullah International Medical Research Center, Jeddah, SAU.
Cureus. 2022 Jul 14;14(7):e26869. doi: 10.7759/cureus.26869. eCollection 2022 Jul.
Giant cell tumors of the bone (GCTB) are rare, benign, aggressive, recurrent tumors that are most often found at the ends of long bones. They account for 5% of all primary bone tumors and 20% of all benign bone tumors. The clinical features of GCTB include local swelling, pain, and limitations in joint movement. Approximately half of GCTB arise around the knee joint, affecting either the distal femur or proximal tibia. Tissue biopsy reveals an excess of multinucleated giant cells on a stromal cell background, indicating a diagnosis. Intralesional curettage is used to treat GCTB and is associated with minimal disability; however, local recurrence may occur in many patients. Resection and endoprosthetic repair or bone graft reconstruction are often used to treat GCTB near the joint. To our knowledge, there are currently no studies on this topic in the city of Jeddah, where we conducted our study. Our aim was to evaluate the outcome of surgical resection accompanied by denosumab injection compared to that of surgery alone in treating GCTB.
All cases of GCTB at King Abdulaziz Medical City, Jeddah, between January 2008 and December 2018, that fulfilled the inclusion and exclusion criteria were included. All cases of GCTB in the pre-specified period were classified as surgical resection with denosumab injection or surgical resection alone. The outcomes of the two modalities were compared. Recurrence was investigated in patients belonging to both the groups.
Twenty-six cases that met the inclusion criteria were included in the study and the data were analyzed. The subjects were divided into two groups: denosumab and surgery (n = 7) and surgery alone (n = 19). Patients treated with denosumab and surgery had a higher recurrence rate (57%); however, the difference was not significant (p = 0.407).
Our study showed that when comparing local recurrence after curettage in patients treated with denosumab and patients who did not receive it, preoperative denosumab therapy was associated with an increased incidence of local recurrence. We recommend a systematic review that can include more studies in this field to acquire more definitive results regarding this topic.
骨巨细胞瘤（GCTB）是一种罕见的、良性的、侵袭性的、复发性肿瘤，最常发生于长骨的末端。它们占所有原发性骨肿瘤的5%，占所有良性骨肿瘤的20%。GCTB的临床特征包括局部肿胀、疼痛和关节活动受限。大约一半的GCTB发生在膝关节周围，影响股骨远端或胫骨近端。组织活检显示在基质细胞背景上有过多的多核巨细胞，以此确诊。病灶内刮除术用于治疗GCTB，且致残率极低；然而，许多患者可能会出现局部复发。关节附近的GCTB通常采用切除及假体修复或骨移植重建进行治疗。据我们所知，在我们开展研究的吉达市，目前尚无关于该主题的研究。我们的目的是评估与单纯手术相比，手术切除联合地诺单抗注射治疗GCTB的效果。
纳入2008年1月至2018年12月在吉达阿卜杜勒阿齐兹国王医疗城符合纳入和排除标准的所有GCTB病例。将预定时期内的所有GCTB病例分为手术切除联合地诺单抗注射组或单纯手术切除组。比较两种治疗方式的效果。对两组患者的复发情况进行调查。
26例符合纳入标准的病例纳入研究并进行数据分析。受试者分为两组：地诺单抗联合手术组（n = 7）和单纯手术组（n = 19）。接受地诺单抗联合手术治疗的患者复发率较高（57%）；然而，差异无统计学意义（p = 0.407）。
我们的研究表明，在比较接受地诺单抗治疗的患者与未接受地诺单抗治疗的患者刮除术后的局部复发情况时，术前使用地诺单抗治疗与局部复发发生率增加相关。我们建议进行一项系统评价，纳入该领域更多研究，以获得关于该主题更确切的结果。
