Li Jilin, Zhang Xiaoming, Xiao Weiguo, Pu Zikun, Liu Changchun, Liu Xilin
Department of Orthopedics, The People's Hospital of TongJiang, Bazhong, 636700, China.
Department of Orthopedics, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China.
Neurosurg Rev. 2025 Feb 13;48(1):230. doi: 10.1007/s10143-025-03342-2.
Spinal giant cell tumors (GCTs) management primarily involves surgical resection; however, the optimal surgical approach continues to be a subject of debate. This study aims to comprehensively compare the efficacy of en-bloc resection with that of control resection techniques, specifically intralesional curettage and piecemeal resection, in the treatment of spinal GCTs. A comprehensive search of English databases, including the Cochrane Library, Embase, PubMed, Scopus, and Web of Science, as well as Chinese databases such as the National Knowledge Infrastructure (CNKI), Chongqing VIP (VIP), and Wan Fang, was conducted up to January 2024. This search identified twelve studies encompassing 492 participants. The meta-analysis indicated that en-bloc resection significantly reduces recurrence rates (OR = 0.27, 95% CI: 0.15-0.47, P < 0.00001) and mortality (OR = 0.16, 95% CI: 0.03-0.88, P = 0.04) when compared to control resection techniques. Notably, en-bloc resection demonstrated superior performance over control methods in both 1-year and 5-year relapse-free survival (RFS) rates (P = 0.001 and P < 0.00001, respectively), as well as in overall RFS (HR = 0.27, 95% CI: 0.08-0.91; P = 0.04). Despite its advantages, en-bloc excision was associated with a higher overall complication rate (P = 0.01). Furthermore, trial sequential analysis (TSA) suggests that the current sample size is inadequate to draw definitive conclusions, thereby underscoring the necessity for further investigations. En-bloc resection shows significant advantages over control resection techniques in reducing recurrence rates, mortality, and improving RFS. However, the higher complication rates and TSA findings stress the need for more high-quality studies to verify the benefits and safety of en-bloc resection in spinal GCT treatment.
脊柱巨细胞瘤（GCTs）的治疗主要涉及手术切除；然而，最佳手术方式仍是一个有争议的话题。本研究旨在全面比较整块切除与对照切除技术（特别是病灶内刮除术和分块切除术）在治疗脊柱GCTs中的疗效。截至2024年1月，对包括Cochrane图书馆、Embase、PubMed、Scopus和Web of Science在内的英文数据库以及中国数据库如中国知网（CNKI）、重庆维普（VIP）和万方进行了全面检索。该检索共纳入了12项研究，涉及492名参与者。荟萃分析表明，与对照切除技术相比，整块切除显著降低了复发率（OR = 0.27，95%CI：0.15 - 0.47，P < 0.00001）和死亡率（OR = 0.16，95%CI：0.03 - 0.88，P = 0.04）。值得注意的是，整块切除在1年和5年无复发生存率（RFS）方面均表现优于对照方法（分别为P = 0.001和P < 0.00001），在总体RFS方面也是如此（HR = 0.27，95%CI：0.08 - 0.91；P = 0.04）。尽管整块切除有其优势，但它与更高的总体并发症发生率相关（P = 0.01）。此外，试验序贯分析（TSA）表明，当前样本量不足以得出明确结论，从而强调了进一步研究的必要性。整块切除在降低复发率、死亡率和改善RFS方面比对照切除技术具有显著优势。然而，较高的并发症发生率和TSA结果强调需要更多高质量研究来验证整块切除在脊柱GCT治疗中的益处和安全性。
