骨盆骨巨细胞瘤临床治疗的系统文献综述

 目的 分析骨盆骨巨细胞瘤（giant cell tumor， GCT）的好发年龄、发病部位、不同治疗方式的复发率及并发症。方法 在医学常用外文数据库检索“giant cell tumor，pelvis”，在医学常用中文数据库检索“骨巨细胞瘤，骨盆”，时间选取1949至2012年，所有被检索的文献及参考文献均被用于分析，经文题、摘要、全文内容二次筛选，共筛选出38篇文献，将所涉及的骨盆GCT患者作为研究对象，删除重复报告的病例；收集每例入选患者的发病年龄、发病部位、手术方式、随访时间、并发症、复发率及死亡率等。采用系统分析的方法对数据进行分项研究。结果 筛选出的38篇文献中共165例骨盆GCT患者纳入研究进行系统分析，发病年龄14~73岁，平均33.2岁，高发年龄21~40岁；男、女比例为1∶1.7。发病部位：髂骨区（A区）48例，髋臼区（B区）60例，耻、坐骨区（C区）31例。随访时间1.5~35年，平均9.5年。27例（32.5%，27/83）患者出现治疗并发症，以病灶外整块切除方式进行治疗的患者（13/28）发生率最高；常见并发症为切口内感染、切口延迟愈合。9例（45.0%，9/20）接受单纯病灶放疗的患者术后复发，24例（33.3%，24/72）接受病灶内手术的患者术后复发，5例（35.7%，5/14）接受病灶内手术联合放疗或冷疗的患者术后复发，1例（2.0%，1/51）接受病灶外手术的患者术后复发，总复发率为24.6%（39/158），死亡率为3.2%（5/158）。结论 骨盆GCT临床少见，常累及髋臼区（B区），高发年龄为21~40岁，病灶外整块切除术后并发症最为常见，但术后复发率最低，骨盆GCT总体复发率较高，死亡率较低。

A systematic review for giant cell tumor in pelvis

Objective To study the morbidity of pelvic giant cell tumors (GCT), and the recurrence and complications of different treatments for giant cell tumors (GCT) in pelvis by systematic review of articles which include related patients'' data. Methods The key words about “giant cell tumor, pelvis” have been used to search articles which include pelvic GCT patients in English and Chinese literature databases from 1949 to 2012. The articles have been filtrated by title, abstract and full text. There are 38 articles used for this study. All the patients are objects of this study, but the same patients'' data in different articles have not been used repeatedly. The patients'' data have been collected as much as possible, including age, location, treatment, follow-up, complication, recurrence, life-or-death situation and so on. All the patients'' data have been used for systematic analysis. Results All of the 38 articles and 165 patients have been studied. The mean onset age was 33.2 years old (range, 14-73 years old) and the peak age of onset was 21 to 40 years old. The gender difference has been uncovered and the sex ratio was 1∶1.7 (male∶female). The acetabular was the most common site for pelvic GCT in this study. 48 tumors were primarily located in the iliac area, 60 in the acetabular area and 31 in the ischiopubic area. 27 patients got complications after treatments, and those patients treated by wide resection had more complications which included incisional infection, delayed healing of incision and so on. 9/20 patients solely treated by irradiation had recurrence, 24/72 patients by intralesional curettage had recurrence and 5/14 by intralesional curettage and irradiation or cryosurgical technique had recurrence. 1/51 patient treated by wide resection had recurrence. The local recurrence was common (24.6%, 39/158) while mortality was low (3.2%, 5/158). Conclusion The pelvic GCT is not common. Acetabular area appears to the most frequent site, and the peek age for pelvic GCT is the third and fourth decade. The recurrence rate is high for all pelvic GCT while the mortality is low. Treatment is one of the most critical influences on recurrence. But for complications, the lower local recurrence rate makes wide resection a reasonable option for patients with extensive and/or aggressive GCT.