恶性骨巨细胞瘤的外科治疗及预后  

Surgical treatment and prognostic analysis of giant cell tumors

作　　者：唐顺[1] 郭卫[1] 杨荣利[1] 鲍冬梅[2] 李大森[1] 

机构地区：[1]北京大学人民医院骨肿瘤科,北京100044 [2]北京大学人民医院病理科,北京100044

出　　处：《中国矫形外科杂志》2015年第5期417-421,共5页Orthopedic Journal of China

摘　　要：[目的]研究恶性骨巨细胞瘤的临床病理和组织学特征,并评估在本中心治疗的恶性骨巨细胞瘤患者的治疗结果和预后。[方法]回顾在本院治疗的所有原发和继发恶性骨巨细胞瘤的病例,共44例,对随访的临床资料进行回顾性研究和统计学相关分析。[结果]共有26例PMGCT和18例SMGCT患者;其中8例SMGCT为放疗后肉瘤变患者。在PMGCT,患者年龄从1～66岁（平均40.6岁）;在SMGCT,患者年龄从22～67岁（平均39.9岁）。从诊断骨巨细胞瘤到诊断SMGCT的平均时间间隔在放疗后SMGCT组为12.8年（4～22年）,在手术后SMGCT组为9.8年（2～28年）。在PMGCT组中,组织分类为骨肉瘤的有13例,恶性纤维组织细胞瘤有9例,纤维肉瘤4例。在SMGCT组中组织学分类为恶性纤维组织细胞瘤13例,骨肉瘤3例,纤维肉瘤2例。29例随访资料完整的恶性骨巨细胞瘤患者的5年生存率为46.9%。广泛切除有助于减少局部复发。[结论]恶性骨巨细胞瘤是一种少见的高度恶性的预后很差的肉瘤。需要注意和良性骨巨细胞瘤相鉴别。广泛切除有助于减少局部复发,辅助化疗及局部放疗在有效控制肿瘤的局部复发和转移中的作用,仍没有得到确认。[Objective] This study aimed to conclude the clinicopathologic and histologic features of malignant giant cell tumors （MGCTs） and to assess the outcome. [ Methods] The clinical data of 44 patients with malignant giant cell tumors ad- mitted to People＇s Hospital （Beijing, China） were retrospectively studied, including 26 primary MGCTs and 18 secondary MGCTs. [Results] Among 18 secondary MGCTs, 8 were post -radiation sarcomas. All patients with primary MGCTs were aged 15 to 66 years （ median, 40. 6years）, and all cases with secondary MGCTs were aged 22 to 67 years （ median, 39.9 years） . The average latent period between diagnosis of giant cell tumor and diagnosis of secondary MGCT was 12. 8 years （ range, 4 - 22 years） for post - radiation sarcomas cases and 9. 8 years （ range, 2 ~ 28 years） for cases resulting from sponta- neous transformation. For primary MGCTs, 13 cases were histologically diagnosed to be osteosarcoma, 9 cases were malignant fi- brous histiocytoma, and 4 cases were fibrosarcoma. For secondary MGCTs, 13 cases were malignant fibrous histiocytoma, 3 ca- ses were osteosarcoma, and 2 cases were fibrosarcoma. The 5 - year survival rate was 46. 9% in 29 patients with active follow - up. The recommended treatment was surgical resection with wide margins. [ Conclusion] Malignanct giant cell tumors are rare high - grade sarcomas with poor outcome. These lesions must be distinguished from benign giant cell tumors of bone. The recom- mended treatment is surgical resection with wide margins. There is insufficient information regarding the benefit of chemotherapy and radiation therapy in the control of local or systemic disease in MCS.

关 键 词：恶性骨巨细胞瘤 骨巨细胞瘤 外科治疗 放疗后肉瘤变 预后因素 

分 类 号：R738.1[医药卫生—肿瘤]