Giant Cell Tumor of Bone: 389 Patients, Analysis of Recurrence Rate and Local Recurrence Risk Factors

David Nikomarov 1 Anthony Griffin 2 Prakash Nayak 2 Shaneel Deo 2 Peter Ferguson 2 Jay Wunder 2
1Orthopaedic Surgery, Rambam Health Care Campus, Haifa, Israel
2Orthopaedic Oncology, Mount Sinai Hospital, Toronto, Canada

Purpose: The uncertainty surrounding giant cell tumor`s (GCTB) clinical course is centered at the inconsistent recurrence rate reports and lack of consensual hard evidence based local recurrence (LR) risk factors. This study is aimed at evaluating the recurrence rate andpossible LR risk factors, by reviewing data from a single high volume orthopedic oncology center.

Methods: Retrospective observational analysis of a clinical registry data was performed. The 389 included patients were operated for the treatment of GCTB between the years 1989 and 2014. Presentation variants evaluated are: patient`s age and gender, anatomical site, Campanacci grade, soft tissue extension, presenting status regarding metastasis, pathologic fractures, and prior LR. Evaluated treatment variants are: surgical technique – resection or curettage, usage of local adjuvant treatment and reconstruction method. Evaluated outcome parameters are: LR free survival, metastasis free survival and complications.

Results: Overall LR rate was 14.9%. Metastasis rate was 2.1%. LR rate in the curettage group was 17.6% compared to 6.4% in the resection group. Metastasis and complications rate were not significantly different between the groups. Recurrence risk reduction after adjuvant treatment was not statistically significant. Age of 30 years or younger and prior LR proved to be risk factors for recurrence. Lesion location at the distal radius showed a clear tendency but was short of statistical significance. Pathologic fracture, Campanacci grade, soft tissue extension and gender did not prove to be significant risk factors.

Conclusion: Accurate prognostication is possible taking into account the basic LR rate and identifying patients at increased risk for recurrence. According to this study, younger patients and those with recurrent lesions or lesions involving the distal radius are prone to recurrences. Extended curettage is a reasonable first line treatment that usually offers acceptable recurrence rates. This risk stratification is recommended for therapeutic planning.