骨巨细胞瘤术后复发原因分析

目的分析骨巨细胞瘤特点与术后复发的相关性。方法回顾性分析获得随访的451例骨巨细胞瘤患者发病部位、手术方式、Campanacci分级、病理性骨折、肺转移与骨巨细胞瘤复发率的相关性。结果脊柱骨盆骨巨细胞瘤的复发率较膝关节周围(P<0.001)、桡骨远端(P=0.005)及其他部位(P<0.001)骨巨细胞瘤复发率高;Ⅲ级骨巨细胞瘤单纯刮除术后复发率高于扩大刮除术(P<0.001)以及瘤段或分块切除术(P=0.002),差异有统计学意义;行单纯刮除术的CampanacciⅠ级、Ⅱ级、Ⅲ级骨巨细胞瘤术后复发率比较差异有统计学意义(P=0.028),行扩大刮除及瘤段或分块切除术后的CampanacciⅡ级与Ⅲ级的骨巨细胞瘤复发率比较差异无统计学意义(P>0.05);骨巨细胞瘤复发病例肺转移率高于无复发病例肺转移率,差异有统计学意义(P<0.001);伴病理性骨折与无病理性骨折骨巨细胞瘤术后复发率比较差异无统计学意义(P>0.05)。结论手术方式影响骨巨细胞瘤的肿瘤外科边界,与术后复发率密切相关;复发病例的肺转移率明显升高;为改善骨巨细胞瘤患者预后,临床上骨巨细胞瘤手术应考虑足够的外科边界。

Risk Factors of Postoperative Recurrence for Giant Cell Tumor of Bone

Objective To investigate the relationship between the characteristics and postoperative recurrence of giant cell tumor (GCT) of bone. Methods A total of 451 patients followed up with GCT of bone undergoing surgical treatment were reviewed to analyze the association of the characteristics, including tumor location, operation method, Campanacci grade, pathological fracture and pulmonary metastasis, with the recurrence rate of GCT bone. Results The recurrence rate of GCT in the spine or pelvis was significantly higher than that around the knee (P<0.001), in distal radius (P=0.005) and in other parts (P<0.001). The recurrence rate of grade Ⅲ GCT after simple excochleation was significantly higher than that after enlarged excochleation (P<0.001) and tumor segment or block resection (P=0.002). The recurrence rate of GCT undergoing simple excochleation among cases of Campanacci gradeⅠ, Ⅱ and Ⅲ was significantly different (P=0.028); however, for GCT undergoing enlarged excochleation and tumor segment or block resection, there was no statistically significant difference of the recurrence rate between cases of gradeⅡ and Ⅲ (P>0.05). The pulmonary metastasis rate in the recurrence cases of GCT was significantly higher than that in no recurrence cases (P<0.001). There was no statistically significant difference of the recurrence rate of GCT between cases with and without pathological fracture (P>0.05). Conclusion The surgical procedure affects the surgical boundary of GCT, which is closely related to the postoperative recurrence rate; the pulmonary metastasis rate of recurrent cases is significantly increased; adequate surgical boundaries for the surgical treatment of GCT may be essential to improve the prognosis of patients with GCT.