Abstract
Giant cell tumor (GCT) of bone is a common primary bone tumor, which exhibits local aggressiveness and recurrent potential, especially for the spinal lesion. Increasing evidence indicates that inflammation plays a vital role in tumorigenesis and progression. The prognostic value of inflammatory biomarkers in GCT has not been established. A retrospective analysis was conducted in patients with spinal GCT in Changzheng Hospital Orthopedic Oncological Center (CHOOC) between January 2005 and October 2015 and 129 patients were identified eligible. Traditional clinical parameters and inflammatory indexes such as Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and albumin/globulin ratio (AGR) were concluded and analyzed. Kaplan-Meier analysis was used to calculate the disease-free survival (DFS). Cox regression analysis was performed to assess the prognostic factors. Nomograms were established to predict DFS quantitatively for the first time, and Harrell’s concordance index (c-index) was adopted to evaluate prediction accuracy. As results, the DFS was 78.3% in the cohort. Patients were stratified into 2 groups by NLR (≤ 2.70 and > 2.70), PLR (≤ 215.80 and > 215.80), LMR (≤ 2.80 and >2.80) and AGR (< 1.50 and ≥ 1.50). Patients with NLR > 2.70, PLR > 215.80, LMR ≤ 2.80 and AGR < 1.50 were significantly associated with decreased DFS (p < 0.05). Multivariate analysis indicated that treatment history, tumor length, bisphosphonate treatment, NLR and PLR were independent factors of DFS (p < 0.05, respectively). In addition, nomogram on DFS was established according to all significant factors, and c-index was 0.728 (95% CI: 0.710-0.743). Nomograms based on DFS can be recommended as practical models to evaluate prognosis for spinal GCT patients.
Highlights
Giant cell tumor (GCT) of bone is a common primary bone tumor and usually occurs in patients aged 20–40 years [1, 2]
High recurrence rate is a typical feature of spinal GCT and an important factor influencing the prognosis
We reported on a large series of GCTs in the spine treated surgically and aimed to give an answer to those questions: 1) Which parameters have the prognostic value for the predicting GCT recurrence?
Summary
Giant cell tumor (GCT) of bone is a common primary bone tumor and usually occurs in patients aged 20–40 years [1, 2]. Spine is a relatively rare site for GCT, accounting for 1.4–9.4% [3]. GCT is predominantly regarded as a benign lesion, but it exhibits local aggressiveness and recurrent potential [4,5,6]. Surgical resection is the fundamental treatment option for GCT in the spine and gross total resection (GTR) realized by en bloc or piece-meal method is the first choice [3, 7]. The postoperative recurrence rate of spinal GCT, which ranges from 20% to 50%, is much higher than the lesion in the extremities [3, 7, 8], even though the GTR is conducted. A better model to predict the prognosis of spinal GCT patients after GTR is urgently needed
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