影响骨巨细胞瘤复发的预后因素分析

目的 分析影响骨巨细胞瘤（giant cell tumor,GCT）术后复发的预后相关因素。方法回顾性分析1990-2003年收治的146例骨巨细胞瘤患者的临床资料,采用单因素,分析性别、年龄、影像学Campanacci分级、病理学Jaffe分级、手术方式、局部处理、发病时间等13项临床因素与GCT复发的关系,并分析Campanacci分级和Jaffe分级的相关性。多因素分析采用Logistic回归分析。结果146例患者获得随访,随访时间24-180个月,平均58个月。本组共19例复发,总复发率为13.0％,局部刮除和瘤段切除后复发率分别为18．8％和6．3％,单纯刮除和扩大刮除复发率分别为38．9％和12．9％。肺转移5例,恶变2例,转移率和恶变率分别为3．4％、1．4％。单因素分析显示肿瘤突破包壳、手术方式（单纯刮除、扩大刮除、瘤段切除）与GCT复发具有相关性,多因素Logistic回归分析显示手术方式是影响复发的重要因素。影像学分级和病理学分级与肿瘤复发不具有相关性。结论手术方式、肿瘤突破包壳与GCT复发相关,手术方式是影响复发的关键因素。

Analysis of the factors affecting the recurrence of giant cell tumor of bone

OBJECTIVE: To analyze the clinical factors affecting the recurrence of giant cell tumors (GCT) of bone. METHODS: The complete data of 146 cases with GCT were reviewed. Thirteen clinical factors were analyzed by chi(2) analysis. And the related Campanacci's grade system and Jaffe's grade system was analyzed by Crosstabs analysis. Multipal factors were analyzed by Logistic regression analysis. RESULTS: Nineteen of 146 cases recurred, and recurrence rate was 13.0%. Recurrence rates of curettage and enblock resection groups were 18.8% and 6.3% respectively. And recurrence rates of curettage with or without of extensive procedure were 12.9% and 38.9%. Five cases had lung metastasis, and two cases presented with malignant transformation. The metastasis rate and the rate of malignant transformation were 3.4% and 1.4% respectively. The two factors of surgery method and burst out of bone-envelope appearance were related with the recurrence. Moreover, Logistic regression revealed that the surgery method significantly affected the recurrence. And Campanacci's grade system and Jaffe's grade system were not related to each other. CONCLUSIONS: Surgery method is the main factor affected the recurrence of GCT, and Campanacci's grade system or Jaffe's grade system has no prognostic value.