Managements of giant cell tumor within the distal radius: A retrospective study of 58 cases from a single center

摘要

Background Giant cell tumor of bone (GCTB) in distal radius is a benign but invasive bone tumor characterized by strong aggressive behavior and frequent recurrence. Methods To identify recurrence related risk factors and decide suitable surgical strategy, the potential tumor- and treatment-specific factors, post-operative oncologic and functional outcomes were collected and analyzed from 58 patients with GCTB of the distal radius at our center. Results With the numbers available, our analysis strongly indicated soft tissue extension (with vs. without, HR: 5.645, 95% CI: 1.424 to 22.377, p ?=?0.014) and size of GCTB (diameter?≥?5?cm vs. 5?cm HR: 3.893, 95% CI: 1.109 to 13.659, p ?=?0.034) are the two independent risk factors related to local relapse. Neither surgical procedures (curettage vs. en-bloc resection) nor other factors apparently affected the recurrence, including age, tumor nature, dominant hand involvement, pathological fracture conditions or pre-operative denosumab. However, intralesional curettage group achieved much better functional scores ((VAS: 2.5?±?0.8?vs. 3.6?±?1.2, p ?=?0.011; MSTS: 20.2?±?3.4?vs. 16.7?±?3.8, P ?=?0.034; DASH 9.1?±?3.9?vs. 16.4?±?5.5, p ?=?0.030) and much less complications (non-unions, dislocations, fractures and infections) compared to resection ones. Furthermore, denosumab provided dramatic pain reduction and strong tumor suppression, facilitating curettage with local adjuvants even in GCTB with advanced status. Conclusions Taken together, the radiographic presentations (soft-tissue extension and tumor size) are the strong prognostic predictors of local recurrence of GCTB in distal radius. In most tumors, an initial treatment with curettage remains feasible and first-choice, especially with the adjuvant denosumab.