Soft tissue extension increases the risk of local recurrence after curettage with adjuvants for giant-cell tumor of the long bones

Figures & data

Figure 1. Flow chart of patients with primary and recurrent GCTB

^a Excluded were patients primarily treated with curettage without PMMA (n = 10), systemic treatment (n = 5), embolization (n = 1), or follow-up of less than 24 months (n = 10).

^b Patients who were primarily treated for GCTB by curettage with adjuvants in a center not specialized in orthopedic oncology, and who were later referred with a first recurrence to our orthopedic oncology center for repeat curettage with adjuvants.

Table 1. Patient demographics

	Primary GCTB (n = 93)	Recurrent GCTB (n = 30)
Sex
Male	55	9
Female	38	21
Location
Proximal humerus	3	1
Distal radius	13	5
Proximal femur	2	2
Distal femur	52	13
Proximal tibia	16	8
Distal tibia	5	1
Fibula	2	–
Tumor characteristics
Soft tissue extension	25	8
Pathological fracture	19	–
Curettage with adjuvants
PMMA and phenol	75	21
PMMA alone	18	9

Table 2. Recurrence-free survival for primary and recurrent GCTB

	n	Rec.	2-year RFS	95% CI	5-year RFS	95% CI	p-value
Primary
Curettage with adjuvants	93	25	0.82	0.73–0.90	0.74	0.65–0.83
PMMA + phenol	75	20	0.83	0.74–0.91	0.74	0.64–0.84	0.9
PMMA alone	18	5	0.78	0.59–0.97	0.72	0.51–0.93
Recurrent
Curettage with adjuvants	30	14	0.63	0.45–0.81	0.45	0.25–0.65
PMMA + phenol	21	9	0.55	0.31–0.79	0.47	0.23–0.72	1.0
PMMA alone	9	5	0.56	0.23–0.88	0.44	0.12–0.77

Rec.: local recurrence; RFS: recurrence-free survival.

Figure 2. Kaplan-Meier estimated recurrence-free survival of primary GCTBs treated with curettage with PMMA and phenol (n = 75; green) or PMMA alone (n = 18; blue ) (p = 0.94).

Figure 3. Kaplan-Meier estimated recurrence-free survival of recurrent GCTBs treated with curettage with PMMA and phenol (n = 21; green) or PMMA alone (n = 9; blue) (p = 0.99).

Table 3. Potential individual risk factors for recurrence in GCTB

	n	Rec.	HR	95% CI	p-value
Potential individual risk factors
Soft tissue extension	25	14	5	2–12	0.001
Distal radius	13	6	2	0.8–5	0.1
Pathological fracture	19	5	1.3	0.5–3.5	0.7
Age under 30	46	13	1.4	0.6–3.2	0.4
Gender	93	25	0.8	0.3–1.8	0.6
Local adjuvants ^a
PMMA alone	18	5
Phenol and PMMA	75	20	0.8	0.3–2.1	0.6

^a Reference was PMMA alone in subanalysis in Cox regression analysis.

Rec.: local recurrence; HR: hazard ratio.

Table 4. Overview of recent studies on risk factors for recurrence and surgical management of primary GCTB

	A	B	C	D	E	F	G	H	I	J
O’Donnell et al. 1994	Single	60	–	–	–	13/30	–	5/30	–	Pathological fracture, soft tissue extension
Becker et al. 2008	Multi-	256	1/48	32/65	–	15/69	13/50	–	–	Soft tissue extension ^a
Balke et al. 2008 ^b	Multi-	214	0/18	32/55	–	19/52	–	7/39	5/42	Soft tissue extension, distal radius ^a
Kivioja et al. 2008	Multi-	294	11/92	24/47	–	32/147	–	–	–	Age ^b
Klenke et al. 2011	Single	118	1/22	7/22	11/32	–	–	0/1	6/40	Age ^a
Current study 2012	Single	93	–	–	–	5/18	20/75	–	–	Soft tissue extension

^a Risk analysis performed using the whole patient population, including resections.

^b In the study, H₂O₂ was used as alternative to phenol.

A Center

B Total

C Resection ^c

D No adjuvants ^c

E Phenol + burr ^c

F PMMA ^c

G PMMA + phenol ^c

H PMMA + burr ^c

I PMMA + phenol + burr ^c

J Risk factors

^c Number of recurrences/total number of patients.

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