Igrec Jasminka, Jernej Lisa, Smolle Maria Anna, Steiner Jakob, Scheipl Susanne, Lohberger Birgit, Leithner Andreas, Brcic Iva
Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, 8010, Graz, Austria.
Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria.
J Orthop Traumatol. 2025 May 3;26(1):27. doi: 10.1186/s10195-025-00841-2.
Advancements in diagnostic and therapeutic modalities for giant cell tumors of bone (GCTB) have introduced molecular and radiological tools that refine clinical decision-making. H3.3 G34W immunohistochemical staining has become a routine diagnostic marker, while H3F3A mutational analysis enhances prognostic insights. Treatment primarily involves surgical methods such as curettage or en bloc resection, with denosumab serving as an adjunct in high-risk or inoperable cases.
We retrospectively analyzed 55 patients with GCTB, focusing on clinicopathologic and radiological findings. Tumors were evaluated using the Campanacci grading system. Immunohistochemical analysis with H3.3 G34W antibody and next-generation sequencing (NGS) were performed to detect H3F3A mutations. A subgroup of nine patients treated with denosumab was further analyzed for clinical outcomes and histological changes.
The cohort had a mean age of 37.7 years, with tumors most commonly affecting the knee joint (55%). All tested tumors demonstrated positive H3.3 G34W staining, with eight exhibiting H3F3A G34W mutations. Recurrence rates were 32% following curettage and 18% after en bloc resection. Denosumab treatment, administered for an average of 14.6 months, facilitated tumor downsizing and new bone formation without major side effects. Histologically, treated tumors showed a depletion of giant cells and increased bone matrix deposition.
Surgery remains the cornerstone of GCTB treatment, with curettage or resection tailored to tumor characteristics. Denosumab offers a valuable adjunct in high-risk cases, enhancing surgical feasibility and promoting joint preservation. The Campanacci grading system continues to be a crucial tool for prognostication and treatment planning, particularly when complemented by molecular and radiological diagnostics. Future research should focus on integrating advanced imaging and artificial intelligence for personalized GCTB management.
Level 4.
骨巨细胞瘤（GCTB）诊断和治疗方式的进步引入了分子和放射学工具，这些工具优化了临床决策。H3.3 G34W免疫组化染色已成为常规诊断标志物，而H3F3A突变分析增强了对预后的认识。治疗主要涉及刮除术或整块切除术等手术方法，地诺单抗在高危或无法手术的病例中作为辅助治疗。
我们回顾性分析了55例GCTB患者，重点关注临床病理和放射学表现。使用坎帕纳奇分级系统对肿瘤进行评估。采用H3.3 G34W抗体进行免疫组化分析和下一代测序（NGS）以检测H3F3A突变。对9例接受地诺单抗治疗的患者亚组进一步分析临床结局和组织学变化。
该队列的平均年龄为37.7岁，肿瘤最常累及膝关节（55%）。所有检测的肿瘤均显示H3.3 G34W染色阳性，其中8例表现为H3F3A G34W突变。刮除术后复发率为32%，整块切除术后为18%。地诺单抗治疗平均持续14.6个月，促进了肿瘤缩小和新骨形成，且无严重副作用。组织学上，接受治疗的肿瘤显示巨细胞减少和骨基质沉积增加。
手术仍然是GCTB治疗的基石，刮除术或切除术根据肿瘤特征进行调整。地诺单抗在高危病例中是一种有价值的辅助治疗，提高了手术可行性并促进了关节保留。坎帕纳奇分级系统仍然是预后评估和治疗计划的关键工具，特别是当与分子和放射学诊断相结合时。未来的研究应专注于整合先进成像和人工智能以实现GCTB的个性化管理。
4级。
