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. Methods: 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 (n= 25, 56%) or spinopelvic region (n= 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. Results: 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). Conclusions: 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：地舒单抗被认为能有效降低骨巨细胞瘤（GCTB）的Campanacci分级，这意味着其主要作用是降低肿瘤分级而非缩小肿瘤体积。术前肿瘤缩小通过减少手术并发症具有重要治疗价值。虽然既往研究观察到部分患者病灶缩小，但尚未有研究明确何种类型的患者可能对治疗产生应答。因此，本研究旨在探索与地舒单抗治疗后GCTB体积缩小相关的临床因素。方法：对45例接受地舒单抗治疗的GCTB患者（女性29例[64%]，男性16例[36%]，中位年龄32岁[范围：17-65岁]）数据进行分析。病灶位于四肢（n=25，56%）或脊柱骨盆区域（n=20，44%），其中10例（22%）为复发病灶。采用两个标准评估病灶缩小情况：最长径缩小≥5%和≥5 mm。对所有变量进行单因素分析，对具有显著性的变量进行多因素分析，并评估多重共线性。根据病灶部位和复发状态进行亚组分析。结果：Campanacci III级可预测所有患者（OR 4.819，95% CI 1.121-20.714）、四肢病灶（OR 11.171，95% CI 1.023-122.014）和原发病灶（OR 5.781，95% CI 1.181-28.297）的比例性缩小（≥5%）；动脉瘤样骨囊肿（ABC）样变与所有患者（OR 8.734，95% CI 1.159-65.845）和原发病灶（OR 11.936，95% CI 1.074-132.69）的绝对缩小（≥5 mm）相关。肿瘤最长径≥7 cm可预测所有患者（OR 12.380，95% CI 1.038-147.694）和脊柱骨盆病灶（OR 20，95% CI 1.676-238.63）的绝对缩小。结论：ABC样变、Campanacci III级和肿瘤最长径可能预测所有患者地舒单抗治疗后GCTB的缩小，但缩小程度因病灶部位和复发状态而异。这些因素有助于临床医生在不同情况下制定个体化治疗策略。需要进一步研究探索临床因素如何从药理学角度影响地舒单抗诱导的GCTB缩小。
肿瘤(癌症)患者之家