Estudo epidemiológico de recidiva de tumor de células gigantes no Instituto Nacional de Traumatologia e Ortopedia

Epidemiological characteristics of 1385 primary sacral tumors in one institution in China

Background

Sacral tumors and tumor-like lesions are a rare group of lesions that can affect children and adults of all ages. Little is known about clinical characteristics of age, gender, histologic type, and anatomic site in China.

Methods

A total of 1385 patients with sacral tumors and tumor-like lesions, which had the clinical record at our bone tumor center from January 2000 to November 2018 were analyzed. The metastatic cancers were not included in the present study.

Results

A total of 51.7% (716 cases) were malignant and 48.3% (669 cases) were benign tumors or tumor-like lesions. Of malignant tumors, chordoma was the most common malignant tumor (316 cases, 22.8% of all tumors), followed by chondrosarcoma, myeloma, and other histologic types. The most common histological type of benign tumors was a giant cell tumor accounting for 14.8% (205 cases) of all tumors, followed by neurofibroma, schwannoma, and other types. The most common age group affected by malignant bone tumors was the 51- to 60-year-old group, followed by the 41- to 50-year-old group. The most commonly affected age group for benign tumors and tumor-like lesions was the 31- to 50-year-old group, followed by the 21- to 30-year old group. Furthermore, the following histologic types had gender predilection. Chordoma, chondrosarcoma, myeloma, and osteosarcoma affected more frequently males than females. Malignant peripheral nerve sheath tumor, lymphoma, giant cell tumor, neurofibroma, tuberculosis, teratoma, and epidermoid cyst more frequently affected females than males.

Conclusions

The large cohort of sacral tumors and tumor-like lesions in our database may reveal their clinical characteristics of age, gender, histologic type, and anatomic site in China and features of sacral tumors and tumor-like lesions are fairly distinct from the mobile spine and extremities.

Increased Risk of Lung Metastases in Patients with Giant Cell Bone Tumors: A Systematic Review

Giant cell tumors of the bone are rare, usually benign, tumors consisting of large, multinucleated bone cells. Remarkably, these tumors are characterized by aggressive growth. They tend to recur frequently and, in rare cases, metastasize to the lungs. Previous studies tried to identify risk factors for lung metastasis by giant cell bone tumors. Those studies reported different results due to a small number of patients. Therefore, a particularly high risk associated with this type of bone tumor prompted this systematic review and meta-analysis to identify risk factors for the development of lung metastases. The risk factors for lung metastasis by giant cell bone tumors searched for in this study were gender, age, lung metastasis and recurrence period, follow-up time, primary or recurrent tumor, Campanacci grading, tumor localization, disease course, treatment of primary and recurrent tumors, and pulmonary metastases treated by surgery, radiation, and chemotherapy. This meta-analysis identified the features outlined above by comparing the groups of patients with giant cell bone tumors and lung metastases with the control group consisting of patients without lung metastases. The search for suitable studies revealed 63 publications with a total of 4,295 patients with giant cell bone tumors. Of these, 247 (5.8%; 95% confidence interval (95%CI) 5.1-6.5%) patients had lung metastases. Further, the risk factors for lung metastases were the following: recurrence (p < 0.0001), lung metastasis time (p < 0.0001), Campanacci grade II (p = 0.028) and grade III (p = 0.006), localization in the lower limbs (p = 0.0007), curettage (p = 0.0005), and local irradiation of the primary tumor (p = 0.008). All studies showed a high-risk bias due to the absence of blinding of the participants, personnel, and outcome assessment. Special attention should be paid to tumor recurrence in the long follow-up time, since more advanced giant cell bone tumors, particularly in lower extremities, tend to reoccur and metastasize to the lung. Surgical treatment and local irradiation should be performed thoughtfully, with extended follow-up periods.