Surgical Strategy for Recurrent Giant Cell Tumor in the Thoracolumbar Spine
Objective Recurrent giant cell tumor (RGCT) of the spine represents a clinical challenge for surgeons, and the treatment strategy remains controversial. This study aims to describe the long‐term follow‐up outcomes and compare the efficacy of en bloc spondylectomy versus piecemeal spondylectomy in tr...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2024-01-01
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| Series: | Orthopaedic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/os.13911 |
| _version_ | 1797357482666885120 |
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| author | Ao Leng Minglei Yang Haitao Sun Zeyu Dai Zhi Zhu Wei Wan Jianru Xiao |
| author_facet | Ao Leng Minglei Yang Haitao Sun Zeyu Dai Zhi Zhu Wei Wan Jianru Xiao |
| author_sort | Ao Leng |
| collection | DOAJ |
| description | Objective Recurrent giant cell tumor (RGCT) of the spine represents a clinical challenge for surgeons, and the treatment strategy remains controversial. This study aims to describe the long‐term follow‐up outcomes and compare the efficacy of en bloc spondylectomy versus piecemeal spondylectomy in treating RGCT of the thoracolumbar spine. Methods A total of 32 patients with RGCT of the thoracolumbar spine treated from June 2012 to June 2019 were retrospectively reviewed. A total of 15 patients received total en bloc spondylectomy (TES) with wide or marginal margin while 17 patients received total piecemeal spondylectomy (TPS) with intralesional margin. Postoperative Eastern Cooperative Oncology Group Performance Score (ECOG‐PS), Frankel classification and recurrence‐free survival (RFS) were evaluated after surgery. Survival curves were estimated by the Kaplan–Meier method and differences were analyzed with the log‐rank test. Multivariate analysis was performed with Cox regression to identify the independent prognostic factors affecting RFS. Results During a median follow‐up of 41.9 ± 17.5 months, all patients with compromised neurologic functions exhibit significant improvement, with the mean ECOG‐PS decreasing from 1.5 ± 1.3 to 0.13 ± 0.3 (p < 0.05). Among the 17 patients treated with TPS, eight patients developed local recurrence after a median time of 15.9 ± 6.4 months and four patients died from progressive disease. On the other hand, local recurrence were well managed with TES, since only one out of 15 patients experienced local relapse and all patients are alive with satisfied function at the latest follow‐up. The median RFS for patients receiving TES and TPS are 75.0 months (95% CI: 67.5–82.5 m) and 38.3 months (95% CI: 27.3–49.3 m) respectively (p = 0.008). Multivariate analysis shows that the Ki67 index (p = 0.016), resection mode (p = 0.022), and denosumab (p = 0.039) are independent risk factors affecting RFS. Conclusions TES with wide/marginal margin should be offered to patients with RGCT whenever feasible, given its long‐term benefits in local control and symptom alleviation. Additionally, patients with lower Ki67 index and application of denosumab tend to have a better prognosis. |
| first_indexed | 2024-03-08T14:45:47Z |
| format | Article |
| id | doaj.art-34145dcb05f64fb4878413f882474959 |
| institution | Directory Open Access Journal |
| issn | 1757-7853 1757-7861 |
| language | English |
| last_indexed | 2024-03-08T14:45:47Z |
| publishDate | 2024-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Orthopaedic Surgery |
| spelling | doaj.art-34145dcb05f64fb4878413f8824749592024-01-11T09:51:57ZengWileyOrthopaedic Surgery1757-78531757-78612024-01-01161788510.1111/os.13911Surgical Strategy for Recurrent Giant Cell Tumor in the Thoracolumbar SpineAo Leng0Minglei Yang1Haitao Sun2Zeyu Dai3Zhi Zhu4Wei Wan5Jianru Xiao6Department of Orthopedic Oncology The Second Affiliated Hospital of Naval Medical University Shanghai ChinaDepartment of Orthopedic Oncology The Second Affiliated Hospital of Naval Medical University Shanghai ChinaDepartment of Orthopedic Oncology The Second Affiliated Hospital of Naval Medical University Shanghai ChinaDepartment of Orthopedic Oncology The Second Affiliated Hospital of Naval Medical University Shanghai ChinaDepartment of Pathology The Second Affiliated Hospital of Naval Medical University Shanghai ChinaDepartment of Orthopedic Oncology The Second Affiliated Hospital of Naval Medical University Shanghai ChinaDepartment of Orthopedic Oncology The Second Affiliated Hospital of Naval Medical University Shanghai ChinaObjective Recurrent giant cell tumor (RGCT) of the spine represents a clinical challenge for surgeons, and the treatment strategy remains controversial. This study aims to describe the long‐term follow‐up outcomes and compare the efficacy of en bloc spondylectomy versus piecemeal spondylectomy in treating RGCT of the thoracolumbar spine. Methods A total of 32 patients with RGCT of the thoracolumbar spine treated from June 2012 to June 2019 were retrospectively reviewed. A total of 15 patients received total en bloc spondylectomy (TES) with wide or marginal margin while 17 patients received total piecemeal spondylectomy (TPS) with intralesional margin. Postoperative Eastern Cooperative Oncology Group Performance Score (ECOG‐PS), Frankel classification and recurrence‐free survival (RFS) were evaluated after surgery. Survival curves were estimated by the Kaplan–Meier method and differences were analyzed with the log‐rank test. Multivariate analysis was performed with Cox regression to identify the independent prognostic factors affecting RFS. Results During a median follow‐up of 41.9 ± 17.5 months, all patients with compromised neurologic functions exhibit significant improvement, with the mean ECOG‐PS decreasing from 1.5 ± 1.3 to 0.13 ± 0.3 (p < 0.05). Among the 17 patients treated with TPS, eight patients developed local recurrence after a median time of 15.9 ± 6.4 months and four patients died from progressive disease. On the other hand, local recurrence were well managed with TES, since only one out of 15 patients experienced local relapse and all patients are alive with satisfied function at the latest follow‐up. The median RFS for patients receiving TES and TPS are 75.0 months (95% CI: 67.5–82.5 m) and 38.3 months (95% CI: 27.3–49.3 m) respectively (p = 0.008). Multivariate analysis shows that the Ki67 index (p = 0.016), resection mode (p = 0.022), and denosumab (p = 0.039) are independent risk factors affecting RFS. Conclusions TES with wide/marginal margin should be offered to patients with RGCT whenever feasible, given its long‐term benefits in local control and symptom alleviation. Additionally, patients with lower Ki67 index and application of denosumab tend to have a better prognosis.https://doi.org/10.1111/os.13911DenosumabEn bloc spondylectomyGiant cell tumor of boneSpinal neoplasms |
| spellingShingle | Ao Leng Minglei Yang Haitao Sun Zeyu Dai Zhi Zhu Wei Wan Jianru Xiao Surgical Strategy for Recurrent Giant Cell Tumor in the Thoracolumbar Spine Orthopaedic Surgery Denosumab En bloc spondylectomy Giant cell tumor of bone Spinal neoplasms |
| title | Surgical Strategy for Recurrent Giant Cell Tumor in the Thoracolumbar Spine |
| title_full | Surgical Strategy for Recurrent Giant Cell Tumor in the Thoracolumbar Spine |
| title_fullStr | Surgical Strategy for Recurrent Giant Cell Tumor in the Thoracolumbar Spine |
| title_full_unstemmed | Surgical Strategy for Recurrent Giant Cell Tumor in the Thoracolumbar Spine |
| title_short | Surgical Strategy for Recurrent Giant Cell Tumor in the Thoracolumbar Spine |
| title_sort | surgical strategy for recurrent giant cell tumor in the thoracolumbar spine |
| topic | Denosumab En bloc spondylectomy Giant cell tumor of bone Spinal neoplasms |
| url | https://doi.org/10.1111/os.13911 |
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