Risk factors of recurrence after surgery for thoracolumbar giant cell tumor

English Keywords:Spine  Giant cell tumor  Surgical treatments  Recurrence rate

English Abstract:

  【Abstract】 Objectives: To investigate the risk factors of recurrence after surgery for thoracolumbar giant cell tumor(GCT). Methods: From January 2005 to September 2010, 20 cases of thoracic and lumbar GCT were operated in our department. There were 10 males and 10 females; the average age at presentation was 34.0 years(range, 11-49 years). 7 cases were younger than 30 years, and 13 cases were between 30-60 years. 13 cases had thoracic lesions and 7 had lumbar spine involved; 15 cases had primary surgery and 5 had revision surgery after GCT recurrence; 15 cases had one vertebra involved, 1 had 2 vertebrae involved and 4 had 3 vertebrae involved. Three types of surgery were used: (1)curettage in 9 cases, (2)intralesional extracapsular excision in 7 cases, (3)en-bloc excision(ES) in 4 cases. The average surgical time was 440.5min(range, 168-690min); the average estimated bleeding was 3268ml(range, 1050-8500ml). 7 cases underwent radiotherapy after surgery. All cases were at Enneking S3 stage. The correlation of incidence of GCT recurrence with gender, age, distribution in spine, primary treatment or not, surgical treatment, surgical time, intraoperative blood loss, postoperative radiation or not was reviewed respectively. The IBM SPSS statistics 19.0 software was used for statistical analysis, the chi-square Fisher′s exact test for the correlation between the above risk factors and incidence of recurrence was analyzed. Results: Among the 20 cases, 3 lost follow-up, and the other 17 cases were followed up for an average of 48 months(18-86 months), 6 cases were noted recurrence. The recurrence rate for thoracic was 3/11, and 3/6 for lumbar, which showed no significant difference(P＞0.05); while the recurrence rate of male was 2/9, and the female recurrence rate was 4/8, which showed no significant difference(P＞0.05); the recurrence rate of the patients below 30 years was 1/6, and that of those 30 to 60 years old was 5/11, which showed no significant difference(P＞0.05); the recurrence rate for the primary surgery cases was 5/13, and that for the revision cases was 1/4, which showed no significant difference(P＞0.05); the recurrence rate with less surgery time(less than 420min) was 4/6, and that with longer surgery time(more than 420min) was 2/11, which showed no significant difference(P＞0.05); the recurrence rate with less bleeding(less than 3000ml) was 2/7, and that with more bleeding(more than 3000ml) was 4/10, which showed no significant difference(P＞0.05); the recurrence rate for curettage was 6/7, and no recurrence was observed in cases with intralesional extracapsular excision and ES, which showed significant difference（P＜0.05）; the recurrence rate for radiotherapy was 5/7, and 1/10 for no radiotherapy, which showed significant difference(P＜0.05). Conclusions: The recurrence rate of thoracolumbar GCT is directly related to the types of surgery. ES and the intralesional extracapsular excision can decrease the recurrence rate significantly.