膝关节骨巨细胞瘤复发的危险因素分析

摘要

目的 探讨膝关节骨巨细胞瘤术后复发的临床及影像学相关危险性因素.方法 回顾性分析来自国内6家骨肿瘤治疗单位的105例膝关节骨巨细胞瘤,包括36例术后局部复发病例和69例术后未复发病例的临床和影像学资料.通过单因素法分析临床因素(包括发病性别、年龄、部位、临床评分、分级、手术方式)和影像学因素与肿瘤术后复发的相关性,将有统计学意义的指标放入多因素Logistic回归方程中确定影响肿瘤复发的相关危险因素.结果 105例患者中,男49例,女56例;随访时间为(45.6±32.1)个月.其中复发组36例,平均年龄(35.64±10.87)岁,复发时间为术后平均(18.9±6.5)个月;未复发组69例,平均年龄(36.32±13.82)岁.单因素x2检验显示病灶边缘清晰或硬化、骨皮质中断、软组织肿块、Hu评分和手术方式与术后复发有关,其他临床因素(发病性别、年龄、部位、Campanacci影像学分级)以及部分影像学因素(膨胀性、多房性或骨性分隔、骨皮质破坏、病理性骨折、病灶是否达到关节面、骨髓水肿、病灶囊性变)与术后复发无关.多因素Logistic回归分析显示边缘清晰或硬化(P=0.048)、软组织肿块(P=0.041)、Hu评分(P=0.040)和手术方式(P=0.001)与肿瘤术后复发密切相关.结论 膝关节骨巨细胞瘤术后复发受多种因素影响,其中病灶边缘模糊、软组织肿块两项影像学征象为独立危险因素,而术前Hu评分和手术方式是影响肿瘤术后复发的重要因素.%Objective To explore the clinical and radiological risk factors of postoperative recurrence in patients with giant cell tumor of bone in knee.Methods We retrospectively analysised 105 cases of giant cell bone tumor of bone in knee from six domestic bone tumor treatment units,including the clinical and radiological data from 36 cases of local post-operative recurrence and 69 non-recurrent cases.We analysised whether the clinical factors(gender,age,location,clinical scoring/grade and surgical procedures)and the radiological factors were in correlation with postoperative recurrence by univariate analysis.Then we integrated the statistically significant indicators into Logistic regression equation to determine the related risk factors for recurrence.Results The study group consisted of 105 cases,including 49 males and 56 females.And the average follow-up time was 45.6± 32.1 months.The recurrent group included 36 cases with average age of 35.64± 10.87 years old and average recurrence time of 18.9±6.5 months.The non-recurrent group included 69 cases with average age of 36.32± 13.82 years old.Univariate x2 analysis suggested that sharp edges or sclerosis of the lesion,cortical destructive interruption,soft tissue mass,Hu scoring and surgical procedures were associated with postoperative recurrence.Other clinical factors (gender,age,location,Campanacci grade) and some radiological factors (swelling,multilocular or osseous interval,cortical damage,pathological fracture,lesion reaching articular surface,bone marrow edema,cystic change) were not associated with postoperative recurrence.The multivariate Logistic regression analysis showed sharp edges or sclerosis of the lesion (p =0.048),soft tissue mass (P=0.041),Hu scoring (P=0.040) and surgical procedures (P=0.001) were closely related to the tumor postoperative recurrence.Conclusion The postoperative recurrence of giant cell tumor of bone in knee is affected by many factors.The radiological findings,including obscure edges of the lesion and soft tissue mass,are independent risk factors.Preoperative Hu scoring and surgical procedures are important factors affecting tumor recurrence.