Therapeutic problems of giant cell tumor in the distal tibia: a multicenter retrospective study

Abstract

Objective To retrospective analysis the onset characteristics and outcome of surgical management in patients with giant cell tumor (GCT) of distal tibia, explore the operation indication and the risk factors for recurrence and limb function. Methods From October 2000 to June 2014, Fifteen patients with GCT in the distal tibia from domestic three bone tumor centers were involved in this study. They included 8 males and 7 females, with an average age of 35.9±10.4 years. There were 11 cases of Campanacci II and 4 cases of Campanacci III. Two cases of Campanacci II occurred pathologic fracture. Expanded curettage surgery was performed in 11 cases and tumor resection with revascularization was performed in 4 cases. Factors influencing the choice of surgery, recurrence and limb function were analyzed. These included tumor size, ankle condition, Campanacci grade, pathological fracture. Results A1l patients were followed up with a mean duration of 62.3±25.2 months, ranging from 26 to 60 months. One of 11 patients treated with extended curettage underwent local recurrence. One of 4 patients treated with marginal excision underwent local recurrence. The effect of Campanacci classification and pathological fracture on selection of operation scheme was analyzed. The effects of pathological fractures, Campanacci classification, surgical methods and postoperative functional score (MSTS score) on postoperative recurrence rate were analyzed. Single factor analysis showed that the pathological fractures did not affect the selection of GCT surgical treatment plan (P=1.000). Campanacci classification affected the selection of GCT surgical treatment plan (P=0.001). Pathological fractures, Campanacci classification and surgical methods were not related to the local recurrence rate (P>0.05). Expanded curettage of Campanacci grade II patients with better postoperative MSTS score than tumor segment resected Campanacci grade Ⅲ patients (t=3.385, P=0.005). There was no significant relationship between pathological fracture and postoperative MSTS score. Conclusion Distal tibia GCT Campanacci classification and whether combined with pathological fracture or not affects the choice of surgical procedure and postoperative functional recovery. Key words: Tibial neoplasms; Giant cell tumor of bone; Muticenter study