Abstract
BACKGROUND: Giant cell tumor of bone (GCTB) in distal radius is a benign but invasive bone tumor characterized by strong aggressive behavior and frequent recurrence. METHODS: To identify recurrence related risk factors and decide suitable surgical strategy, the potential tumor- and treatment-specific factors, post-operative oncologic and functional outcomes were collected and analyzed from 58 patients with GCTB of the distal radius at our center. RESULTS: With the numbers available, our analysis strongly indicated soft tissue extension (with vs. without, HR: 5.645, 95% CI: 1.424 to 22.377, p = 0.014) and size of GCTB (diameter ≥ 5 cm vs. 5 cm HR: 3.893, 95% CI: 1.109 to 13.659, p = 0.034) are the two independent risk factors related to local relapse. Neither surgical procedures (curettage vs. en-bloc resection) nor other factors apparently affected the recurrence, including age, tumor nature, dominant hand involvement, pathological fracture conditions or pre-operative denosumab. However, intralesional curettage group achieved much better functional scores ((VAS: 2.5 ± 0.8 vs. 3.6 ± 1.2, p = 0.011; MSTS: 20.2 ± 3.4 vs. 16.7 ± 3.8, P = 0.034; DASH 9.1 ± 3.9 vs. 16.4 ± 5.5, p = 0.030) and much less complications (non-unions, dislocations, fractures and infections) compared to resection ones. Furthermore, denosumab provided dramatic pain reduction and strong tumor suppression, facilitating curettage with local adjuvants even in GCTB with advanced status. CONCLUSIONS: Taken together, the radiographic presentations (soft-tissue extension and tumor size) are the strong prognostic predictors of local recurrence of GCTB in distal radius. In most tumors, an initial treatment with curettage remains feasible and first-choice, especially with the adjuvant denosumab.