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Wang Q, Zhang Y, Zhang E, Xing X, Chen Y, Nie K, Yuan H, Su MY, Lang N. A Multiparametric Method Based on Clinical and CT-Based Radiomics to Predict the Expression of p53 and VEGF in Patients With Spinal Giant Cell Tumor of Bone. Front Oncol 2022; 12:894696. [PMID: 35800059 PMCID: PMC9253421 DOI: 10.3389/fonc.2022.894696] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeThis project aimed to assess the significance of vascular endothelial growth factor (VEGF) and p53 for predicting progression-free survival (PFS) in patients with spinal giant cell tumor of bone (GCTB) and to construct models for predicting these two biomarkers based on clinical and computer tomography (CT) radiomics to identify high-risk patients for improving treatment.Material and MethodsA retrospective study was performed from April 2009 to January 2019. A total of 80 patients with spinal GCTB who underwent surgery in our institution were identified. VEGF and p53 expression and clinical and general imaging information were collected. Multivariate Cox regression models were used to verify the prognostic factors. The radiomics features were extracted from the regions of interest (ROIs) in preoperative CT, and then important features were selected by the SVM to build classification models, evaluated by 10-fold crossvalidation. The clinical variables were processed using the same method to build a conventional model for comparison.ResultsThe immunohistochemistry of 80 patients was obtained: 49 with high-VEGF and 31 with low-VEGF, 68 with wild-type p53, and 12 with mutant p53. p53 and VEGF were independent prognostic factors affecting PFS found in multivariate Cox regression analysis. For VEGF, the Spinal Instability Neoplastic Score (SINS) was greater in the high than low groups, p < 0.001. For p53, SINS (p = 0.030) and Enneking stage (p = 0.017) were higher in mutant than wild-type groups. The VEGF radiomics model built using 3 features achieved an area under the curve (AUC) of 0.88, and the p53 radiomics model built using 4 features had an AUC of 0.79. The conventional model built using SINS, and the Enneking stage had a slightly lower AUC of 0.81 for VEGF and 0.72 for p53.Conclusionp53 and VEGF are associated with prognosis in patients with spinal GCTB, and the radiomics analysis based on preoperative CT provides a feasible method for the evaluation of these two biomarkers, which may aid in choosing better management strategies.
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Affiliation(s)
- Qizheng Wang
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Yang Zhang
- Department of Radiological Sciences, University of California Irvine, Irvine, CA, United States
- Department of Radiation Oncology, Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Enlong Zhang
- Department of Radiology, Peking University International Hospital, Beijing, China
| | - Xiaoying Xing
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Yongye Chen
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Ke Nie
- Department of Radiation Oncology, Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Min-Ying Su
- Department of Radiological Sciences, University of California Irvine, Irvine, CA, United States
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
- *Correspondence: Ning Lang, ; Min-Ying Su,
| | - Ning Lang
- Department of Radiology, Peking University Third Hospital, Beijing, China
- *Correspondence: Ning Lang, ; Min-Ying Su,
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Zhou L, Lin S, Zhu H, Dong Y, Yang Q, Yuan T. The blood pressure and use of tourniquet are related to local recurrence after intralesional curettage of primary benign bone tumors: a retrospective and hypothesis-generating study. BMC Musculoskelet Disord 2022; 23:201. [PMID: 35241034 PMCID: PMC8892695 DOI: 10.1186/s12891-022-05157-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 02/25/2022] [Indexed: 11/29/2022] Open
Abstract
Aims Intralesional curettage is a commonly used treatment for primary bone tumors. However, local recurrence of tumors after curettage remains a major challenge. Questions (1) Is blood pressure related to local recurrence after intralesional curettage for benign or intermediate bone tumors? (2) What’s the impact of tourniquet usage on the risk of recurrence from high blood pressure? Methods This retrospective study evaluated patients receiving intralesional curettage for primary bone tumors from January 2011 to January 2015. A total of 411 patients with a minimum five-year follow-up were included for analysis. Demographic and disease-related variables were first assessed in univariable analyses for local recurrence risk. When a yielded p-value was < 0.2, variables were included in multivariable analyses to identify independent risk factors for local recurrence. Patients were then stratified by tourniquet usage (use/non-use), and risk from high blood pressure was evaluated in both subgroups. Results At an average follow-up of 6.8 ± 1.0 years, 63 of 411 patients (15.3%) experienced local recurrence. In multivariable analyses, local recurrence was associated with age (OR, 0.96; 95% CI, 0.94–0.99; p = 0.005); tumor type; lesion size (> 5 cm: OR, 3.58; 95% CI, 1.38–9.33; p = 0.009); anatomical site (proximal femur: OR, 2.49; 95% CI, 1.21–5.15; p = 0.014; proximal humerus: OR, 3.34; 95% CI, 1.61–6.92; p = 0.001); and preoperative mean arterial pressure (> 110 mmHg: OR, 2.61; 95% CI, 1.20–5.67; P = 0.015). In subgroup analyses, after adjusting for age, tumor type, lesion size, and anatomical site, tourniquet use modified the preoperative mean arterial pressure - recurrence relationship: when tourniquet was not used, preoperative mean arterial pressure predicted local recurrence (95–110 mmHg, 4.13, 1.42–12.03, p = 0.009; > 110 mmHg, 28.06, 5.27–149.30, p < 0.001); when tourniquet was used, preoperative mean arterial pressure was not related to local recurrence (all p values > 0.05). Conclusions A high preoperative blood pressure was related to local recurrence after intralesional curettage for primary bone tumors in our study. Tourniquet usage and controlling blood pressure might be beneficial for reducing local recurrence in patients scheduled to receive intralesional curettage for primary bone tumor treatment. Level of evidence Level IV, hypothesis-generating study. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05157-4.
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Affiliation(s)
- Lenian Zhou
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Shanyi Lin
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Hongyi Zhu
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Yang Dong
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Qingcheng Yang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
| | - Ting Yuan
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
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Furuta T, Kubo T, Sakuda T, Saito T, Kurisu K, Muragaki Y, Adachi N. Utility of intraoperative magnetic resonance imaging for giant cell tumor of bone after denosumab treatment: a pilot study. Acta Radiol 2022; 63:176-181. [PMID: 33517664 DOI: 10.1177/0284185121989515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Giant cell tumor of bone (GCTB) is an intermediate but locally aggressive neoplasm. Current treatment of high-risk GCTB involves administration of denosumab, which inhibits bone destruction and promotes osteosclerosis. However, denosumab monotherapy is not a curative treatment for GCTB and surgical treatment remains required. Denosumab treatment complicates surgery, and the recurrence rate of GCTB is high (20%-30%). PURPOSE To examine the utility of intraoperative magnetic resonance imaging (iMRI) for detection and reduction of residual tumor after denosumab treatment and to investigate the utility of iMRI, which is not yet widely used. MATERIAL AND METHODS We enrolled five patients who received denosumab for a median period of eight months (range 6-12 months). Surgery was performed when the degree of osteosclerosis around the articular surface was deemed appropriate. We performed iMRI using a modified operation table to identify residual tumor after initial curettage and evaluated the rate of detection of residual tumor by iMRI, intraoperative and postoperative complications, exposure time of iMRI, and operation time. RESULTS Suspected residual tumor tissue was identified in all five cases and was confirmed by histopathology after additional curettage. The rate of detection of residual tumor by iMRI was 100%. Residual tumor was located in sites which were difficult to remove due to osteosclerosis. The iMRI was performed safely and without trouble. During the median follow-up period of 10 months (range 6-24 months), no adverse events or recurrences occurred. CONCLUSION Intraoperative MRI could contribute to the reduction of residual tumor tissue and it may prevent recurrence of GCTB after denosumab therapy.
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Affiliation(s)
- Taisuke Furuta
- Department of Orthopaedic Surgery, Hiroshima University, Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Tadahiko Kubo
- Department of Orthopaedic Surgery, Hiroshima University, Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Tomohiko Sakuda
- Department of Orthopaedic Surgery, Hiroshima University, Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Taiichi Saito
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Hiroshima University, Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yoshihiro Muragaki
- Faculty of Advanced Techno-Surgey, Tokyo Women’s Medical University, Tokyo, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Hiroshima University, Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
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Parmeggiani A, Miceli M, Errani C, Facchini G. State of the Art and New Concepts in Giant Cell Tumor of Bone: Imaging Features and Tumor Characteristics. Cancers (Basel) 2021; 13:6298. [PMID: 34944917 PMCID: PMC8699510 DOI: 10.3390/cancers13246298] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 12/12/2022] Open
Abstract
Giant cell tumor of bone (GCTB) is classified as an intermediate malignant tumor due to its locally aggressive behavior, burdened by high local recurrence rate. GCTB accounts for about 4-5% of all primary bone tumors and typically arises in the metaphysis and epiphyses of the long tubular bones. Mutation of gene H3F3A is at the basis of GCTB etiopathogenesis, and its immunohistochemical expression is a valuable method for practical diagnosis, even if new biomarkers have been identified for early diagnosis and for potential tumor recurrence prediction. In the era of computer-aided diagnosis, imaging plays a key role in the assessment of GCTB for surgical planning, patients' prognosis prediction and post treatment evaluation. Cystic changes, penetrating irregular margins and adjacent soft tissue invasion on preoperative Magnetic Resonance Imaging (MRI) have been associated with a higher rate of local recurrence. Distance from the tumor edge to the articular surface and thickness of unaffected cortical bone around the tumor should be evaluated on Computed Tomography (CT) as related to local recurrence. Main features associated with local recurrence after curettage are bone resorption around the graft or cement, soft tissue mass formation and expansile destruction of bone. A denosumab positive response is represented by a peripherical well-defined osteosclerosis around the lesion and intralesional ossification. Radiomics has proved to offer a valuable contribution in aiding GCTB pre-operative diagnosis through clinical-radiomics models based on CT scans and multiparametric MR imaging, possibly guiding the choice of a patient-tailored treatment. Moreover, radiomics models based on texture analysis demonstrated to be a promising alternative solution for the assessment of GCTB response to denosumab both on conventional radiography and CT since the quantitative variation of some radiomics features after therapy has been correlated with tumor response, suggesting they might facilitate disease monitoring during post-denosumab surveillance.
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Affiliation(s)
- Anna Parmeggiani
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (M.M.); (G.F.)
| | - Marco Miceli
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (M.M.); (G.F.)
| | - Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy;
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (M.M.); (G.F.)
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Zhou L, Zhu H, Lin S, Jin H, Zhang Z, Dong Y, Yang Q, Zhang C, Yuan T. Computerised tomography features of giant cell tumour of the knee are associated with local recurrence after extended curettage. INTERNATIONAL ORTHOPAEDICS 2021; 46:381-390. [PMID: 34783889 PMCID: PMC8782792 DOI: 10.1007/s00264-021-05260-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/01/2021] [Indexed: 11/28/2022]
Abstract
Background Extended curettage has increasingly become the preferred treatment for giant cell tumour of bone (GCTB), but the high recurrence rate after curettage poses a major challenge for orthopaedic surgeons. Computed tomography (CT) is valuable in the evaluation of GCTB. Our aim was to identify specific features of GCTB around the knee in pre-operative CT images that might have prognostic value for local recurrence. Methods We retrospectively analyzed data from 124 patients with primary GCTB around the knee who underwent extended curettage from 2010 through 2019. We collected demographic, clinical, and therapeutic data along with several CT-derived tumour characteristics. CT-derived tumor characteristics included tumour size, the distance between the tumour edge and articular surface (DTA), and destruction of posterior cortical bone (DPC). Akaike information criterion (AIC) was used to select which variables to enter into multivariate logistic regression models and to determine significant factors affecting recurrence. Results The total recurrence rate was 21.0% (26/124), and the average follow-up time was 69.5 ± 31.2 months (24–127 months). Age, DTA (< 2 mm), and DPC were significantly related to recurrence, as determined by multivariate logistic regression. The C-index of the final model was 0.79 (95% CI: 0.71 to 0.88), representing a good model for predicting recurrence. Conclusion Identifying certain features of GCTB around the knee on CT has prognostic value for patients treated with extended curettage. A three-factor model predicts tumour recurrence well after extended curettage. Supplementary Information The online version contains supplementary material available at 10.1007/s00264-021-05260-6.
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Affiliation(s)
- Lenian Zhou
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Hongyi Zhu
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Shanyi Lin
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Hanqiang Jin
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Zhaoyuan Zhang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Yang Dong
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Qingcheng Yang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Changqing Zhang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
- Institute of Microsurgery On Extremities, Shanghai Jiaotong University Affiliated Sixth, People's Hospital, Shanghai, 200233, China.
| | - Ting Yuan
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
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Yapar A, Atalay İB, Tokgöz MA, Ulucaköy C, Güngör BŞ. Prognostic significance of the preoperative neutrophil-to-lymphocyte ratio patients with giant cell tumor of bone. Afr Health Sci 2021; 21:1250-1258. [PMID: 35222589 PMCID: PMC8843307 DOI: 10.4314/ahs.v21i3.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate the prognostic significance of neutrophil-to-lymphocyte ratio (NLR) in giant cell tumor of bone (GCT). Methods The patients with GCT were identified in the hospital records and pre-treatment complete blood count results were acquired retrospectively. Whether preoperative NLR lymphocyte-to-monocyte ratio (LMR) and platelet-to-lymphocyte ratio (PLR) values had prognostic significance in predicting recurrence was evaluated by Receiver operating curve (ROC) analysis. Furthermore, the prognostic value of NLR was evaluated by Multivariable Cox Regression analysis. Results There were 96 patients with GCT. It was found that only NLR values had prognostic significance for predicting recurrence (AUC:0.647; 95% CI:0.533–0.762; P=0.021). The statistically significant cut-off value of NLR for predicting recurrence was ≥2.25. NLR was ≥2.25 in 51% (n = 49) of patients. Multivariable analysis showed that NLR ≥2.25 (HR=2.9, 95% CI:1.3–6.6; p=0.009) and lung metastasis (HR=7.9, 95% CI:2.2–28.2; p=0.001) were independent factors of recurrence. In patients with lung metastasis and patients with NLR ≥2.25, recurrence was observed in a sooner period (Log rank test; p=0.001; p=0.009, respectively). Conclusion Our findings showed that NLR is a new and promising inflammation-based prognostic factor in GCT patients.
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Affiliation(s)
- Aliekber Yapar
- Department of Orthopaedics and Traumatology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - İsmail Burak Atalay
- Department of Orthopaedics and Traumatology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Mehmet Ali Tokgöz
- Department of Orthopaedics and Traumatology, Dr. Nafiz Korez Sincan State Hospital, Ankara, Turkey
| | - Coşkun Ulucaköy
- Department of Orthopaedics and Traumatology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Bedii Şafak Güngör
- Department of Orthopaedics and Traumatology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
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Zhou L, Lin S, Jin H, Zhang Z, Zhang C, Yuan T. Preoperative CT for prediction of local recurrence after curettage of giant cell tumor of bone. J Bone Oncol 2021; 29:100366. [PMID: 34040954 PMCID: PMC8143997 DOI: 10.1016/j.jbo.2021.100366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/03/2021] [Accepted: 04/04/2021] [Indexed: 10/29/2022] Open
Abstract
•Preoperative CT images of GCTBs have value in prognostic prediction.•Certain features of GCTBs on CT images are related to local recurrence.•Our models' predictions for GCTB patients accepting extensive curettage are good.
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Affiliation(s)
- Lenian Zhou
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Shanyi Lin
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Hanqiang Jin
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Zhaoyuan Zhang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Changqing Zhang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China.,Institute of Microsurgery on Extremities, Shanghai Jiaotong University Affiliated Sixth, People's Hospital, Shanghai, 200233, China
| | - Ting Yuan
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
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