Abstract
Background
Giant cell tumor (GCT) of the mobile spine is a benign tumor, but it can be potentially aggressive. There is not much published information on GCT of the mobile spine as a result of rarity of the disease, and there are controversies over prognostic factors of the condition.
Methods
A retrospective analysis of GCT of the mobile spine was performed by survival analysis. Recurrence-free survival (RFS) was defined as the interval between the date of surgery and the date of recurrence. The postoperative RFS rate was estimated by the Kaplan–Meier method. Factors with P values of ≤0.1 were subjected to multivariate analysis for RFS by proportional hazard analysis. P values of ≤0.5 were considered statistically significant.
Results
A total of 102 patients with GCT of the mobile spine were included in the study. The mean follow-up period was 39.9 (median 26.0, range 2–153) months. Thirty-eight patients developed recurrence. The univariate and multivariate analysis suggested that age less than 40 years, total spondylectomy either by en bloc or piecemeal method, and administration of bisphosphonate were independent favorable prognostic factors. Subgroup analysis by excluding patients before the year 2000 further confirmed our findings.
Conclusions
The removal of the entire osseous compartment either by en bloc or piecemeal method in combination with the long-term use of bisphosphonate could significantly reduce the recurrence rate of GCT of the mobile spine. Age less than 40 years is a favorable prognostic factor for GCT in the mobile spine.
Similar content being viewed by others
References
Campanacci M, Baldini N, Boriani S, Sudanese A. Giant-cell tumor of bone. J Bone Joint Surg Am. 1987;69:106–14.
Werner M. Giant cell tumour of bone: morphological, biological and histogenetical aspects. Int Orthop. 2006;30:484–9.
Goldenberg RR, Campbell CJ, Bonfiglio M. Giant-cell tumor of bone. An analysis of two hundred and eighteen cases. J Bone Joint Surg Am. 1970;52:619–64.
Larsson SE, Lorentzon R, Boquist L. Giant-cell tumor of bone. A demographic, clinical, and histopathological study of all cases recorded in the Swedish cancer registry for the years 1958 through 1968. J Bone Joint Surg Am. 1975;57:167–73.
Sanjay BK, Sim FH, Unni KK, McLeod RA, Klassen RA. Giant-cell tumours of the spine. J Bone Joint Surg Br. 1993;75:148–54.
Gamberi G, Benassi MS, Ragazzini P, et al. Proteases and interleukin-6 gene analysis in 92 giant cell tumors of bone. Ann Oncol. 2004;15:498–503.
Dahlin DC. Caldwell Lecture. Giant cell tumor of bone: highlights of 407 cases. AJR Am J Roentgenol. 1985;144:955–60.
Eckardt JJ, Grogan TJ. Giant cell tumor of bone. Clin Orthop Relat Res. 1986;(204):45–58.
Boriani S, Bandiera S, Casadei R, et al. Giant cell tumor of the mobile spine: a review of 49 cases. Spine (Phila Pa 1976). 2012;37:E37–45.
Savini R, Gherlinzoni F, Morandi M, Neff JR, Picci P. Surgical treatment of giant-cell tumor of the spine. The experience at the Istituto Ortopedico Rizzoli. J Bone Joint Surg Am. 1983;65:1283–9.
Hart RA, Boriani S, Biagini R, Currier B, Weinstein JN. A system for surgical staging and management of spine tumors. A clinical outcome study of giant cell tumors of the spine. Spine (Phila Pa 1976). 1997;22:1773–82.
Martin C, McCarthy EF. Giant cell tumor of the sacrum and spine: series of 23 cases and a review of the literature. Iowa Orthop J. 2010;30:69–75.
Junming M, Cheng Y, Dong C, et al. Giant cell tumor of the cervical spine: a series of 22 cases and outcomes. Spine (Phila Pa 1976). 2008;33:280–8.
Tse LF, Wong KC, Kumta SM, Huang L, Chow TC, Griffith JF. Bisphosphonates reduce local recurrence in extremity giant cell tumor of bone: a case–control study. Bone. 2008;42:68–73.
Frankel HL, Hancock DO, Hyslop G, et al. The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I. Paraplegia. 1969;7:179–92.
Sanerkin NG. Malignancy, aggressiveness, and recurrence in giant cell tumor of bone. Cancer. 1980;46:1641–9.
Boriani S, Weinstein JN, Biagini R. Primary bone tumors of the spine. Terminology and surgical staging. Spine (Phila Pa 1976). 1997;22:1036–44.
Chan P, Boriani S, Fourney DR, et al. An assessment of the reliability of the Enneking and Weinstein–Boriani–Biagini classifications for staging of primary spinal tumors by the spine oncology study group. Spine (Phila Pa 1976). 2009;34:384–91.
Boriani S, Biagini R, De Iure F, et al. En bloc resections of bone tumors of the thoracolumbar spine. A preliminary report on 29 patients. Spine (Phila Pa 1976). 1996;21:1927–31.
Tomita K, Kawahara N, Baba H, Tsuchiya H, Fujita T, Toribatake Y. Total en bloc spondylectomy. A new surgical technique for primary malignant vertebral tumors. Spine (Phila Pa 1976). 1997;22:324–33.
Song S, Hong JC, McDonnell SE, et al. Combined modality therapy for rectal cancer: the relative value of posttreatment versus pretreatment CEA as a prognostic marker for disease recurrence. Ann Surg Oncol. 2012;19:2471–6.
Bertoni F, Bacchini P, Staals EL. Malignancy in giant cell tumor of bone. Cancer. 2003;97:2520–9.
Thomas DM, Skubitz KM. Giant cell tumour of bone. Curr Opin Oncol. 2009;21:338–44.
Guo C, Yan Z, Zhang J, et al. Modified total en bloc spondylectomy in thoracic vertebra tumour. Eur Spine J. 2011;20:655–60.
Cheng YY, Huang L, Lee KM, Xu JK, Zheng MH, Kumta SM. Bisphosphonates induce apoptosis of stromal tumor cells in giant cell tumor of bone. Calcif Tissue Int. 2004;75:71–7.
Chang SS, Suratwala SJ, Jung KM, et al. Bisphosphonates may reduce recurrence in giant cell tumor by inducing apoptosis. Clin Orthop Relat Res. 2004;(426):103–9.
Balke M, Campanacci L, Gebert C, et al. Bisphosphonate treatment of aggressive primary, recurrent and metastatic giant cell tumour of bone. BMC Cancer. 2010;10:462.
Zhang W, Zhang Y, Li P, et al. Administration of sodium ibandronate in the treatment of complicated giant cell tumor of the spine. Spine (Phila Pa 1976). 2011;36:E1166–72.
Otto S, Sotlar K, Ehrenfeld M, Pautke C. Osteonecrosis of the jaw as a possible rare side effect of annual bisphosphonate administration for osteoporosis: a case report. J Med Case Rep. 2011;5:477.
Nascimento AG, Huvos AG, Marcove RC. Primary malignant giant cell tumor of bone: a study of eight cases and review of the literature. Cancer. 1979;44:1393–402.
Gong L, Liu W, Sun X, et al. Histological and clinical characteristics of malignant giant cell tumor of bone. Virchows Arch. 2012;460:327–34.
Ozkan E, Gupta S. Embolization of spinal tumors: vascular anatomy, indications, and technique. Tech Vasc Interv Radiol. 2011;14:129–40.
Vetter SC, Strecker EP, Ackermann LW, Harms J. Preoperative embolization of cervical spine tumors. Cardiovasc Interv Radiol. 1997;20:343–7.
Zhen W, Yaotian H, Songjian L, Ge L, Qingliang W. Giant-cell tumour of bone. The long-term results of treatment by curettage and bone graft. J Bone Joint Surg Br. 2004;86:212–6.
Durr HR, Maier M, Jansson V, Baur A, Refior HJ. Phenol as an adjuvant for local control in the treatment of giant cell tumour of the bone. Eur J Surg Oncol. 1999;25:610–8.
Malawer MM, Bickels J, Meller I, Buch RG, Henshaw RM, Kollender Y. Cryosurgery in the treatment of giant cell tumor. A long-term followup study. Clin Orthop Relat Res. 1999;(359):176–88.
Wei F, Liu X, Liu Z, et al. Interferon alfa-2b for recurrent and metastatic giant cell tumor of the spine: report of two cases. Spine (Phila Pa 1976). 2010;35:E1418–22.
Kaiser U, Neumann K, Havemann K. Generalised giant-cell tumour of bone: successful treatment of pulmonary metastases with interferon alpha, a case report. J Cancer Res Clin Oncol. 1993;119:301–3.
Thomas D, Henshaw R, Skubitz K, et al. Denosumab in patients with giant-cell tumour of bone: an open-label, phase 2 study. Lancet Oncol. 2010;11:275–80.
Acknowledgment
This study was supported in part by the National Natural Science Foundation of China (Grant 81102036).
Author information
Authors and Affiliations
Corresponding author
Additional information
Wei Xu, Xiang Li and Wending Huang contributed equally to this study, and all should be considered first author.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Xu, W., Li, X., Huang, W. et al. Factors Affecting Prognosis of Patients with Giant Cell Tumors of the Mobile Spine: Retrospective Analysis of 102 Patients in a Single Center. Ann Surg Oncol 20, 804–810 (2013). https://doi.org/10.1245/s10434-012-2707-6
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-012-2707-6