Effects of TPX2 on proliferation, apoptosis and activated cysteine containing aspartate proteinase-3 expression of human lung cancer cells

Abstract

Objective To restospectively analyze the treatment and efficacy of giant cell tumor(GCT) in proximal humerus, specify the indications and precautions for different surgical methods and analysis the risk factors for recurrence and shoulder dysfunction. Methods The retrospective case-control study was conducted. From January 2002 to June 2015, the complete clinical data of 27 patients with giant cell tumor of the proximal humerus in the Second Affiliated Hospital of Inner Mongolia Medical University, the 960th Hospial of PLA, Tianjin Hospital and Third Hospital of Medical University were collected. Among them, there were 15 males and 12 females, with age of 18-55(33.1±12.2) years. Twenty-seven patients with initial treatment and follow-up for more than 3 years were included in the study. There were 17 patients with pathological fracture, 14 cases with fracture displacement, 3 cases with pathological fracture but no displacement; Campanacci grade Ⅱ GCT was diagnosed in 17 patients; Campanacci grade Ⅲ GCT in 10 patients, 14 cases of curettage in the initial operation (3 cases of scraping, 11 cases of enlarged scraping), of which 10 patients were treated with plate screw internal fixation. There were 2 cases of autogenous bone grafting, 1 case of autologous plus allogeneic bone grafting, 3 cases of allogeneic bone grafting, 8 cases of bone cement filling to fill the bone defect. Thirteen cases underwent resection and reconstruction of the tumor, including 10 cases of semi-shoulder joint replacement and 3 cases of intramedullary nail fixation with large allograft. The patients were followed up regularly and the effects of upper shoulder joint function were evaluated according to the Musculoskeletal Tumor Society(MSTS) score. Statistical analysis was performed using SPSS 22.0 statistical software. The recurrence rate and complication rate, the upper limb MSTS score, the analysis of the influencing factors of surgical approach selection and the risk factors of tumor recurrence were compared by univariate analysis between the tumor segment resection group and the risk factors for tumor recurrence. Results All the patients were followed up for 36 to 180 (92.4±38.9) months. There was 1 local recurrence in each of the curettage and tumor resection, and the recurrence rate was 1/14 and 2/13. Four patients with tumor resection had postoperative complications, and the total complication rate was 14.8%(4/27). Among them, 2 patients with large segmental allografts underwent semi-shoulder arthroplasty; 1 patient with subluxation of shoulder joint; 1 patient with prosthesis loosening exposed for 36 months after surgery had to undergo revision surgery with replacement of cemented prosthesis. The incidence of complications of intracapsular curettage was lower than that of tumor resection, and the difference was statistically significant(P=0.041). Single factor analysis showed that there was no correlation between pathological fracture and surgical methods (r=-0.037, P=1.000), Campanacci grading was correlated with surgical methods (r=0.482, P 0.05). The postoperative shoulder function of the patients with scrape reconstruction was significantly better than that of the tumor reconstruction (P<0.01). Conclusions The giant cell tumor of the proximal humerus is prone to pathological fracture compared with other sites. The recurrence rate is lower after curettage or tumor resection, but the latter has high postoperative complications. The shoulder function of the scraping group was significantly better than that of the tumor segment group. Due to the high incidence of complications after resection of the tumor, especially the bone resorption after resection of large segmental allografts. Intracapsular curettage should be selected as a treatment of giant cell tumor in proximal humerus. Key words: Giant cell tumor of bone; Proximal humerus; Curettage; Resection; Multicenter study