Kemiğin dev hücreli tümörlerinde rekürrens ve akciğer metastazı arasındaki ilişki

Year 2020, Volume: 11 Issue: 2, 23 - 28, 21.03.2020

Aliekber Yapar , İsmail Burak Atalay , Coşkun Ulucaköy , Recep Öztürk , Yaman Karakoç

https://doi.org/10.18663/tjcl.675773

Cited By: 2

Abstract

Amaç: Bu çalışmanın amacı, kliniğimizde kemiğin dev hücreli tümörü tanısı ile takip ve tedavi edilen hastalarda rekürrens ve akciğer metastazı arasındaki ilişkiyi değerlendirmek ve rekürrensi etkileyen diğer faktörleri sunmaktır.

Gereç ve Yöntemler: Bu çalışma kesitsel tanımlayıcı tipte bir çalışmadır. Ankara Onkoloji Eğitim ve Araştırma Hastanesi Ortopedi ve Travmatoloji kliniğinde Ocak 2002- Aralık 2018 tarihleri arasında kemiğin dev hücreli tümörü nedeniyle tedavisi ve takibi yapılan hastalar retrospektif olarak taranmıştır. Tanı yaş ortalaması 31,6 ±13,3 (8-69) olan 52’si erkek 62’si kadın toplam 114 hasta çalışmaya dahil edilmiştir.

Bulgular: Bu çalışmaya katılan hastaların ortalama takip süresi 63,1±33,4 (14-192) aydır. Hastaların  %26,3’ünde ortalama 17,1 ayda (6-36 ay arası) rekürrens gelişirken, %4,4’ünde (5 hasta) akciğerde metastaz saptanmıştır. Rekürrens gelişen hastaların %13,3’ünde akciğer metastazı gözlenirken rekürrens gelişmeyenlerin %1,2’sinde akciğer metastazı gözlenmiştir. Rekürrens gelişen hastalarda rekürrens gelişmeyen gruba göre akciğer metastazı istatistiksel olarak anlamlı düzeyde daha fazla gözlenmiştir (p=0,017). Akciğer metastazının rekürrense kadar geçen süreler dikkate alınarak rekürrens gelişmesi üzerine olan etkisi Cox Regresyon analizi ile incelenmiştir. Akciğer metastazı için hesaplanan Hazard Ratio (HR): 12,8 (%95 GA:1,4-119,5; p=0,026) bulunmuştur.

Sonuç: Kemiğin dev hücreli tümörleri, öngörülemeyen davranışları olan lokal agresif nadir metastaz yapan tümörlerdir ve en sık metastaz akciğerleredir. Çalışmamızda hastalar rekürrens durumlarına göre değerlendirildiğinde rekürrensi olan hastaların % 13,3' ünde, rekürrensi olmayan hastaların % 1.2' sinde akciğer metastazı gözlendi. Akciğer metastazı, rekürrens olan hasta grubunda rekürrens olmayan gruba göre anlamlı derecede yüksek bulunmuştur.

Keywords

Kemiğin dev hücreli tümörü;, Rekürrens, Akciğer Metastazı

The relationship between recurrence and lung metastasis in giant cell tumor of bone

Abstract

Aim: The aim of this study is to evaluate the relationship between recurrence and lung metastasis in patients diagnosed with giant cell tumor of bone treated in our clinic and to present the other factors affecting the recurrence.

Material and Methods: The patients who were treated and followed up for a giant cell tumor of the bone between 2002 and 2018 were retrospectively reviewed. A total of 114 patients with a mean age of 31.6 ± 13.3 were included in the study.

Results: The mean follow-up period was 63.1 ± 33.4 months. Recurrence occurred in 26.3% (30 patients) of the patients in a mean of 17.1 months, while metastasis in the lung was found in 4.4% (5 patients). When the patients were evaluated according to their recurrence status, lung metastasis was observed in 13.3% of the patients with recurrence, while lung metastasis was observed in 1.2% of the patients without recurrence. Lung metastasis was found to be significantly higher in patients with recurrence than in the group without recurrence (p = 0.017). For lung metastasis, Hazard Ratio (HR) was calculated as 12.8 (95% CI: 1.4-119.5; p = 0.026).

Conclusion: Giant cell tumors of the bone are locally aggressive tumors with unpredictable behavior. In our study, when the patients were evaluated according to their recurrence status, lung metastasis was observed in 13.3% of the patients with recurrence, and 1.2% of the patients without recurrence. Lung metastasis was found to be significantly higher in patients with recurrence than in the group without recurrence.

Keywords

Giant cell tumor of bones, Recurrence, Lung metastasis

References

• 1. Fletcher CD, Unni KK, and Mertens F. Pathology and genetics of tumours of soft tissue and bone. 3rd ed. Iarc; 2002
• 2. Enneking WF. Musculoskeletal tumor surgery. Lesions of Uncertain Origin Originating in Bone, 1983.
• 3. Jung ST et al, Multicentric giant cell tumor in adolescents: three case reports. Journal of Pediatric Orthopaedics B. 2013; 22: 282-87.
• 4. Atalay IB, Öztürk R, Şimşek MA, Erdoğdu Yİ, Güngör BŞ. Giant cell tumors of bone localized in distal radius. Ann Clin Anal Med 2019 DOI: 10.4328/ACAM. 20011
• 5. Niu X et al, Giant cell tumor of the extremity: retrospective analysis of 621 Chinese patients from one institution. JBJS 2012; 94: 461-67.
• 6. Werner M, Giant cell tumour of bone: morphological, biological and histogenetical aspects. International Orthopaedics. 2006; 30: 484-489.
• 7. Chakarun CJ et al. Giant cell tumor of bone: review, mimics, and new developments in treatment. Radiographics. 2013; 33: 197-211.
• 8. Turcotte RE et al. Giant cell tumor of long bone: a Canadian Sarcoma Group study. Clinical Orthopaedics and Related Research 2002; 397: 248-58.
• 9. Errani C et al, Giant cell tumor of the extremity: a review of 349 cases from a single institution. Cancer Treatment Reviews 2010; 36: 1-7.
• 10. Kirby E et al. CO2 laser cauterization of giant-cell tumor margins. Clinical Orthopaedics And Related Research 1990; 253: 231-39.
• 11. Siebenrock K, Unni K, Rock M, Giant-cell tumour of bone metastasising to the lungs: a long-term follow-up. The Journal Of Bone And Joint Surgery 1998; 80: 43-47.
• 12. Yayan J. Increased Risk of Lung Metastases in Patients with Giant Cell Bone Tumors: A Systematic Review. Adv Exp Med Biol 2019; 1176: 1-17.
• 13. Van der Heijden L, Dijkstra PD, Van de Sande MA, Kroep JR, Nout RA, van Rijswijk CS, Bovée JV, Hogendoorn PC, Gelderblom H. The clinical approach toward giant cell tumor of bone. Oncologist 2014; 19: 550-61.
• 14. Ozturk R. Kemik ve yumuşak doku Tümorleri. In: Atay T, ed. Ortopedi ve Spor Yaralanmaları Asistan Kitabı. Ankara, Derman Tıbbi Yayıncılık; 2015
• 15. Teixeira LEM, Vilela JCS, Miranda RH et al. Dev hücreli kemik tümörü: Lokal nüks ile ilişkili olan cerrahi dışı faktörler. Acta Orthop Traumatol Turc 2014; 48: 136-40.
• 16. Muheremu A, Niu X. Pulmonary metastasis of giant cell tumor of bones. World J Surg Oncol 2014;12: 261.
• 17.Blackley HR, Wunder JS, Davis AM, White LM, Kandel R, Bell RS. Treatment of giant-cell tumors of long bone swith curettage and bone-grafting. J Bone Joint Surg Am 1999; 81: 811–20.
• 18. Chakarun CJ1, Forrester DM, Gottsegen CJ, Patel DB, White EA, Matcuk GR Jr. Giant cell tumor of bone: review, mimics, and new developments in treatment. Radiographics 2013; 33: 197-211.
• 19. Jaffe H L, Lichtenstein L, Portis R B. Giant cell tumor of bone: Its pathologic appearance, grading, supposed variants and treatment. Arch Pathol 1940; 30: 993-1031.
• 20. Campanacci M, Baldini N, Boriani S, Sudanese A. Giant-cell tumor of bone. J Bone Joint Surg (Am) 1987; 69: 104-14.
• 21. Bertoni F, Bacchini P, Staals EL. Malignancy in giant cell tumor of bone. Cancer 2003; 97: 2520–29.
• 22. Hoch B, Hermann G, Klein MJ, Abdelwahab IF, Springfield D. Giant cell tumor complicating Paget disease of long bone. Skeletal Radiol 2007; 36: 973–78.