Abstract
PurposeGiant cell tumor of bone (GCTB) is an intermittent tumor with a low probability of pulmonary metastasis. Our aim was to investigate the risk factors and establish a nomogram predictive model for GCTB pulmonary metastasis.MethodsWe retrospectively evaluated GCTB patients at our center from 1991 to 2014. The cohort was randomized into training and validation sets. Univariate and multivariate analyses were used to evaluate the risk factors of pulmonary metastasis. A nomogram was established. Internal validation was achieved based on ROC curve and C-index values in the validation set. Decision curve analysis was performed to assess the clinical performance of the nomogram.Results417 patients were studied, including benign and malignant GCTBs. The average follow up was 79 months. Pulmonary metastases were observed in 27 cases. Four independent risk factors were identified: malignancy, tumor bearing time, times of recurrence and tumor size. A nomogram was developed to predict pulmonary metastasis with C-index values of 0.857 and 0.785 in the training and validation groups. In the decision curve analysis, patients could benefit from the nomogram, which differentiates patients at high risk for pulmonary metastasis and avoids unnecessary examination. According to the nomogram, patients with final risks of more than 0.06 should be scheduled for further chest scans.ConclusionMalignancy, tumor bearing time, times of recurrence and tumor size were independent risk factors for pulmonary metastasis in GCTB patients. The nomogram can accurately predict the risk of pulmonary metastasis and help doctors to make clinical decisions for further chest examinations.
Highlights
Giant cell tumor of bone (GCTB) is a relatively uncommon intermediate bone tumor with strong local aggressiveness
The nomogram can accurately predict the risk of pulmonary metastasis and help doctors to make clinical decisions for further chest examinations
Finch and Gleave first described pulmonary metastasis in benign GCTB, prior to which metastasis was only associated with malignant GCTBs [6]
Summary
Giant cell tumor of bone (GCTB) is a relatively uncommon intermediate bone tumor with strong local aggressiveness. GCTB accounts for approximately 3%-5% of primary bone tumors and shows a relatively high incidence in Chinese populations [1, 2]. Few GCTBs (1%-6%) transform into malignancies, after radiotherapy or multiple local surgeries and recurrences [3,4,5]. Distal metastasis of benign GCTBs occurs in various sites, including the lung, liver and skin, and www.impactjournals.com/oncotarget pulmonary metastases are most commonly observed [7,8,9,10]. Reflecting the low incidence of GCTBs and the pulmonary metastasis of this tumor, studies of the etiology or risk analysis of this disease are limited. Some authors have suggested that vascular invasion and iatrogenic embolization might be attributed to metastasis, additional evidence is needed to confirm this hypothesis [11,12,13,14]
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