Giant cell tumour of bone (GCTB) is one of the most common local aggressive tumourous lesions with a wide variety of biological behaviour. However, there are no clear indicative criteria when choosing the type of procedure and the complication rates remain high, especially in terms of local recurrence. The purpose of the study was to (1) identify the main risk factors for local recurrence, (2) evaluate the recurrence-free survival in dependence on neoadjuvant denosumab use and the type of procedure, and (3) compare the functional outcomes after curettage and en bloc resection. The group included 102 patients with GCTB treated between 2006 and 2020. The mean age of patients was 34.4 years (15–79). The follow-up period was 8.32 years (2–16) on average. Local recurrence occurred in 14 patients (29.8%) who underwent curettage and in 5 patients (10.6%) after en bloc resection. Curettage was shown to be a factor in increasing recurrence rates (OR = 3.64 [95% CI: 1.19–11.15];p= 0.023). Tibial location was an independent risk factor for local recurrence regardless of the type of surgery (OR = 3.22 [95% CI: 1.09–9.48];p= 0.026). The recurrence-free survival rate of patients treated with resection and denosumab was higher compared to other treatments at five years postoperatively (p= 0.0307). Functional ability and pain as reported by patients at the latest follow-up were superior after curettage compared to resection for upper and lower extremity (mean difference: −4.00 [95% CI: –6.81 to −1.18];p< 0.001 and mean difference: −5.36 [95% CI: −3.74 to −6.97];p< 0.001, respectively). Proximal tibia tumour location and curettage were shown to be major risk factors for local recurrence in GCTB regardless of neoadjuvant denosumab treatment. The recurrence-free survival rate of patients treated with resection and denosumab was higher compared to other treatments. The functional outcome of patients after curettage was better compared to en bloc resection.
骨巨细胞瘤是一种具有广泛生物学行为的常见局部侵袭性肿瘤病变。然而，在选择手术方式时缺乏明确的指征标准，且并发症发生率仍然较高，尤其在局部复发方面。本研究旨在：(1) 确定局部复发的主要危险因素，(2) 评估基于新辅助地诺单抗使用和手术方式的无复发生存率，(3) 比较刮除术与整块切除术后的功能结果。研究纳入了2006年至2020年间接受治疗的102例骨巨细胞瘤患者，平均年龄34.4岁（范围15-79岁），平均随访时间8.32年（范围2-16年）。刮除术后局部复发14例（29.8%），整块切除术后复发5例（10.6%）。刮除术被证实是增加复发率的危险因素（OR=3.64[95%CI:1.19-11.15]；p=0.023）。无论手术方式如何，胫骨病灶均为局部复发的独立危险因素（OR=3.22[95%CI:1.09-9.48]；p=0.026）。接受切除术联合地诺单抗治疗的患者在术后五年的无复发生存率显著高于其他治疗方式（p=0.0307）。末次随访时患者报告的功能状态和疼痛评分显示，四肢病灶刮除术后的功能结果均优于切除术（上肢平均差：-4.00[95%CI:-6.81至-1.18]；p<0.001；下肢平均差：-5.36[95%CI:-3.74至-6.97]；p<0.001）。研究表明，无论是否接受新辅助地诺单抗治疗，胫骨近端病灶和刮除术都是骨巨细胞瘤局部复发的主要危险因素。切除术联合地诺单抗治疗可获得更高的无复发生存率，而刮除术后的功能结果优于整块切除术。
肿瘤(癌症)患者之家