CAJ | 학술논문

目的探讨膝关节骨巨细胞瘤术后复发的临床及影像学相关危险性因素.方法回顾性分析来自国内6家骨肿瘤治疗单位的105例膝关节骨巨细胞瘤,包括36例术后局部复发病例和69例术后未复发病例的临床和影像学资料.通过单因素法分析临床因素(包括发病性别、年龄、部位、临床评分、分级、手术方式)和影像学因素与肿瘤术后复发的相关性,将有统计学意义的指标放入多因素Logistic回归方程中确定影响肿瘤复发的相关危险因素.结果 105例患者中,男49例,女56例;随访时间为(45.6±32.1)个月.其中复发组36例,平均年龄(35.64±10.87)岁,复发时间为术后平均(18.9±6.5)个月;未复发组69例,平均年龄(36.32±13.82)岁.单因素x2检验显示病灶边缘清晰或硬化、骨皮质中断、软组织肿块、Hu评分和手术方式与术后复发有关,其他临床因素(发病性别、年龄、部位、Campanacci影像学分级)以及部分影像学因素(膨胀性、多房性或骨性分隔、骨皮质破坏、病理性骨折、病灶是否达到关节面、骨髓水肿、病灶囊性变)与术后复发无关.多因素Logistic回归分析显示边缘清晰或硬化(P=0.048)、软组织肿块(P=0.041)、Hu评分(P=0.040)和手术方式(P=0.001)与肿瘤术后复发密切相关.结论膝关节骨巨细胞瘤术后复发受多种因素影响,其中病灶边缘模糊、软组织肿块两项影像学征象为独立危险因素,而术前Hu评分和手术方式是影响肿瘤术后复发的重要因素.
목적 탐토슬관절골거세포류술후복발적림상급영상학상관위험성인소.방법 회고성분석래자국내6가골종류치료단위적105례슬관절골거세포류,포괄36례술후국부복발병례화69례술후미복발병례적림상화영상학자료.통과단인소법분석림상인소(포괄발병성별、년령、부위、림상평분、분급、수술방식)화영상학인소여종류술후복발적상관성,장유통계학의의적지표방입다인소Logistic회귀방정중학정영향종류복발적상관위험인소.결과 105례환자중,남49례,녀56례;수방시간위(45.6±32.1)개월.기중복발조36례,평균년령(35.64±10.87)세,복발시간위술후평균(18.9±6.5)개월;미복발조69례,평균년령(36.32±13.82)세.단인소x2검험현시병조변연청석혹경화、골피질중단、연조직종괴、Hu평분화수술방식여술후복발유관,기타림상인소(발병성별、년령、부위、Campanacci영상학분급)이급부분영상학인소(팽창성、다방성혹골성분격、골피질파배、병이성골절、병조시부체도관절면、골수수종、병조낭성변)여술후복발무관.다인소Logistic회귀분석현시변연청석혹경화(P=0.048)、연조직종괴(P=0.041)、Hu평분(P=0.040)화수술방식(P=0.001)여종류술후복발밀절상관.결론 슬관절골거세포류술후복발수다충인소영향,기중병조변연모호、연조직종괴량항영상학정상위독립위험인소,이술전Hu평분화수술방식시영향종류술후복발적중요인소.
Objective To explore the clinical and radiological risk factors of postoperative recurrence in patients with giant cell tumor of bone in knee.Methods We retrospectively analysised 105 cases of giant cell bone tumor of bone in knee from six domestic bone tumor treatment units,including the clinical and radiological data from 36 cases of local post-operative recurrence and 69 non-recurrent cases.We analysised whether the clinical factors(gender,age,location,clinical scoring/grade and surgical procedures)and the radiological factors were in correlation with postoperative recurrence by univariate analysis.Then we integrated the statistically significant indicators into Logistic regression equation to determine the related risk factors for recurrence.Results The study group consisted of 105 cases,including 49 males and 56 females.And the average follow-up time was 45.6± 32.1 months.The recurrent group included 36 cases with average age of 35.64± 10.87 years old and average recurrence time of 18.9±6.5 months.The non-recurrent group included 69 cases with average age of 36.32± 13.82 years old.Univariate x2 analysis suggested that sharp edges or sclerosis of the lesion,cortical destructive interruption,soft tissue mass,Hu scoring and surgical procedures were associated with postoperative recurrence.Other clinical factors (gender,age,location,Campanacci grade) and some radiological factors (swelling,multilocular or osseous interval,cortical damage,pathological fracture,lesion reaching articular surface,bone marrow edema,cystic change) were not associated with postoperative recurrence.The multivariate Logistic regression analysis showed sharp edges or sclerosis of the lesion (p =0.048),soft tissue mass (P=0.041),Hu scoring (P=0.040) and surgical procedures (P=0.001) were closely related to the tumor postoperative recurrence.Conclusion The postoperative recurrence of giant cell tumor of bone in knee is affected by many factors.The radiological findings,including obscure edges of the lesion and soft tissue mass,are independent risk factors.Preoperative Hu scoring and surgical procedures are important factors affecting tumor recurrence.