脊柱骨巨细胞瘤术后复发相关影响因素分析

Analysis of risk factors for recurrence of spinal giant cell tumor

目的探讨脊柱骨巨细胞瘤术后复发的相关影响因素，为降低术后复发风险及指导治疗提供参考。方法回顾性分析2000年1月至2016年6月就诊于5家骨肿瘤治疗中心（第四军医大学西京医院、河北医科大学第三医院、济南军区总医院、天津医院、浙江医科大学附属第二医院）的脊柱GCT患者73例，男29例，女44例；年龄13-60岁，平均（33．73±11．34）岁。归纳对可能影响肿瘤复发的因素：性别、年龄、既往复发病史、肿瘤部位、Ennecking分期、术前Frankel分级、临床症状、手术方式、手术人路、术前动脉栓塞、术后辅助放疗和二膦酸盐治疗，采用单因素分析与多因素Logistic回归分析研究上述影响因素与肿瘤复发的关系。结果随访时间为4-210个月，平均61．81~53．21个月。随访结果显示18例患者肿瘤术后复发，首次术后复发时间为4-87个月，平均17．44±19．73个月。单因素分析结果显示，手术方式（P=0．026）、辅助放疗（P=0．018），复发病史（P=0．028）及二膦酸盐治疗（P=0．017）与脊柱GCT术后复发显著相关。多因素Logistic回归分析结果显示手术方式（P=0．027）和二膦酸盐治疗（P=0．002）是肿瘤术后复发的独立危险因素。结论采用全椎节切除的手术方式及应用二膦酸盐治疗可以明显降低活动节段脊柱GCT患者术后复发率。

Objective To investigate the factors related to the local recurrence of spine giant cell tumor （GCT） after surgi- cal treatment and provide a reference for the treatment. Methods A retrospective analysis of GCT of the spine from January 2000 to June 2016 was conducted. A total of 73 patients with GCT of the spine who underwent surgical treatment in Giant Cell Tu- mor Team of China （GTOC） were collected, including 29 males and 44 females. The average age was 33.73±11.34 years （range： 13- 60 years）. Clinical characteristics including gender, age, history of recurrence, tumor position, Ennecking stage, Frankel score, clinical symptoms, surgery procedures, surgical approach, preoperative selective artery embolism （PAE）, radiotherapy and bisphos- phonate treatment history are collected. The correlation between the factors and tumor recurrence were analyzed by single factor analysis and multiple-factor logistic regression. Results The mean follow-up time was 61.81±53.21 months （range： 4-210 months）. Surgical procedures, bisphosphonate treatment, history of recurrence and radiotherapy were found significant correlation with tumor recurrence by single factor analysis. The result of multiple-factor logistic regression showed that surgical procedures （P=0.026） and bisphosphonate treatment （P=0.017） were independent risk factors for tumor recurrence. Conclusion Total spon-dylectomy and bisphosphonate treatment could significantly reduce the recurrence rate of GCT of the spine.