Anract P, De Pinieux G, Cottias P, Pouillart P, Forest M, Tomeno B
Department of Orthopaedic Surgery, Hôpital Cochin, University of Paris V, France.
Int Orthop. 1998;22(1):19-26. doi: 10.1007/s002640050201.
Twenty-nine patients with malignant giant-cell tumours of bone (GCT) were followed-up for between 6 months and 18 years. Seventeen of the tumours were primary and 12 were due to malignant degeneration of initially benign lesions. The clinical features did not differ from those of benign GCT, except for a higher incidence in the distal tibia and sacrum. Anaplastic GCTs were included in the study because their clinical and radiographic features and prognosis were no different from those of the GCT grade III of Jaffe. Eighteen of the tumours were grade III, and 11 were anaplastic. This retrospective study was intended to assess the effects of chemotherapy and surgery for malignant GCT. Three treatment groups were selected, in which treatment was either by surgery alone, surgery plus chemotherapy, or radiotherapy alone.--The prognosis was poor and the 5 year tumour-free survival rate in the series was 50%. The prognosis was the same for primary as for secondarily malignant tumours. There was no statistical difference in survival between malignant grade III and anaplastic malignant tumours. The one-year survival rate for patients treated by chemotherapy and surgery was statistically higher (chi2 test) than for persons treated by surgery alone. However, the five-year survival rate and the actuarial survival curves were not statistically different in the two groups (log rank test).--Chemotherapy appears to be of some value in the treatment of these malignant tumours but a larger series is required to confirm the efficacy of this approach.
29例骨恶性巨细胞瘤（GCT）患者接受了6个月至18年的随访。其中17例为原发性肿瘤，12例由最初的良性病变恶变而来。除了在胫骨远端和骶骨的发病率较高外，其临床特征与良性GCT并无差异。间变性GCT被纳入本研究，因为它们的临床、影像学特征及预后与Jaffe分级III级的GCT并无不同。18例肿瘤为III级，11例为间变性。本回顾性研究旨在评估化疗和手术对恶性GCT的疗效。选取了三个治疗组，分别采用单纯手术、手术加化疗或单纯放疗进行治疗。——预后较差，该系列的5年无瘤生存率为50%。原发性和继发性恶性肿瘤的预后相同。III级恶性肿瘤和间变性恶性肿瘤的生存率无统计学差异。化疗联合手术治疗患者的1年生存率在统计学上高于单纯手术治疗者（卡方检验）。然而，两组的5年生存率和精算生存曲线并无统计学差异（对数秩检验）。——化疗似乎对这些恶性肿瘤的治疗有一定价值，但需要更大规模的系列研究来证实这种治疗方法的疗效。
