Joo Min Wook, Park Se-Jun, Kim Wanlim, Kim Yongsung, Cho Jae Hwan, Bernthal Nicholas Matthew, Lee Minpyo, Lee Jewoo, Lee Yong-Suk
Department of Orthopaedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA 90095, USA.
Cancers (Basel). 2025 Jun 24;17(13):2121. doi: 10.3390/cancers17132121.
BACKGROUND/OBJECTIVES: Denosumab has been considered effective for downstaging giant cell tumor of bone (GCTB), implying that it lowers the Campanacci grade rather than reducing tumor size. Preoperative tumor shrinkage holds therapeutic value by decreasing surgical complications. While previous studies have observed lesion shrinkage in some patients, no study has identified the types of patients likely to show treatment response. Thus, we sought to identify the clinical factors associated with post-denosumab GCTB size reduction.
The data for 45 GCTB patients (29 females [64%], 16 males [36%], median age 32 years [range: 17-65]) who received denosumab were analyzed. Lesions were in the extremities ( = 25, 56%) or spinopelvic region ( = 20, 44%). Ten (22%) were recurrent. Lesion size reduction was assessed using two criteria: a ≥5% and a ≥5 mm decrease in the longest diameter. Univariate analyses were conducted for all variables, and those found to be significant were subjected to multivariate analyses. In addition, multicollinearity was evaluated. Subgroup analyses were performed based on lesion location and recurrence status.
Campanacci grade III predicted proportional shrinkage (≥5%) in all patients (OR 4.819, 95% CI 1.121-20.714) and in extremity (OR 11.171, 95% CI 1.023-122.014) and primary lesions (OR 5.781, 95% CI 1.181-28.297), and aneurysmal bone cyst (ABC)-like change was associated with absolute shrinkage (≥5 mm) in all patients (OR 8.734, 95% CI 1.159-65.845) and primary lesions (OR 11.936, 95% CI 1.074-132.69). The longest tumor diameter of ≥7 cm predicted absolute shrinkage in all patients (OR 12.380, 95% CI 1.038-147.694) and for spinopelvic lesions (OR 20, 95% CI 1.676-238.63).
ABC-like change, Campanacci grade III, and the longest tumor diameter might predict post-denosumab GCTB shrinkage in all patients, though shrinkage varies with lesion location and recurrence status. These factors could help clinicians tailor treatment strategies in different settings. Further research is needed to explore how clinical factors pharmacologically influence denosumab-induced GCTB shrinkage.
背景/目的：地诺单抗已被认为对降低骨巨细胞瘤（GCTB）分期有效，这意味着它降低了坎帕纳奇分级，而非减小肿瘤大小。术前肿瘤缩小可通过减少手术并发症而具有治疗价值。虽然既往研究观察到部分患者的病灶缩小，但尚无研究确定可能出现治疗反应的患者类型。因此，我们试图确定与地诺单抗治疗后GCTB大小减小相关的临床因素。
分析了45例接受地诺单抗治疗的GCTB患者的数据（29例女性[64%]，16例男性[36%]，中位年龄32岁[范围：17 - 65岁]）。病灶位于四肢（n = 25，56%）或脊柱骨盆区域（n = 20，44%）。10例（22%）为复发病灶。使用两个标准评估病灶大小减小情况：最长径减少≥5%和≥5 mm。对所有变量进行单因素分析，将有显著意义的变量进行多因素分析。此外，评估了多重共线性。根据病灶位置和复发状态进行亚组分析。
坎帕纳奇III级预测所有患者（比值比[OR] 4.819，95%置信区间[CI] 1.121 - 20.714）、四肢病灶（OR 11.171，95% CI 1.023 - 122.014）和原发灶（OR 5.781，95% CI 1.181 - 28.297）的比例性缩小（≥5%），骨囊肿样改变与所有患者（OR 8.734，95% CI 1.159 - 65.845）和原发灶（OR 11.936，95% CI 1.074 - 132.69）的绝对缩小（≥5 mm）相关。最长肿瘤直径≥7 cm预测所有患者（OR 12.
