Influence of age factor on the prognosis of giant cell tumor at mobile spine

English Keywords:Spinal tumor  Giant cell tumor of bone  Recurrence  Prognosis  Age

English Abstract:

  【Abstract】 Objectives: To find out whether age factor is associated with the recurrence rate of giant cell tumor at mobile spine. Methods: A retrospective review on cases with giant cell tumor of spine treated at Peking University Third Hospital from March 1989 to December 2011 was performed, this series included 25 males and 37 females, with a mean age of 32 years. 28 cases had defect at cervical spine, 24 at thoracic spine, and 10 at lumbar spine. Radiologically, 36 tumors were limited in 1 vertebra, and 26 in 2 or more. There were 60 cases classified as S3, and 2 cases as S2. According to the WBB Staging Diagram, posterior element was involved in only 2 cases, while vertebral body was involved in 15 cases, and 45 had both sites involved. As for the treatment, intralesional intracapsular excision was performed on 9 cases, intralesional extracapsular excision in 45, and en bloc excision in 8. Routine follow-up was conducted in 53 patients, with a median follow-up of 63 months and a minimum follow-up of 21 months. Vertebral levels involved and vertebral column involved were compared between patients below and above 25yr. Recurrence rate was compared among cases of different age groups with an Enneking stage. Statistical analysis was done by SPSS 19.0. Results: 20 patients were 25yr or below(25yr or below group), and 42 were above 25yr(above 25yr group). There were 6(6/20) cases involved in more than 1 level in the 25yr or below group, while 20(20/42) in the above 25yr group, which showed no statistical significance between two age groups(P=0.1). In the 25yr or below group, 2 cases had defect located at the posterior element of vertebra, 7 at the vertebral body and 11 at both. While in the above 25yr group, none were merely located at the posterior element, 8 at the vertebral body and 34 at both(P=0.03). There were a total of 18(33%) recurrences, with median recurrence duration of 12 months. Among the cases with an Enneking stage of S3 and intralesional extracapsular excision, the relapse free survival rate of 25yr or below group was higher than that of the above 25yr group(P=0.03). When dividing groups of ten yr interval, the recurrence rate was 0%(0/6) in 11-20yr group, 23%(3/13) in 21-30yr group, 33.3%(2/6) in 31-40yr group and 57.1%(4/7) in 41-50yr group, which showed increasing recurrence rate with age. Conclusions: In cases with the same Enneking stage and the same surgical treatment, age appears to be associated with the recurrence rate of giant cell tumor at mobile spine, young patients tend to have better prognosis.