地舒单抗新辅助联合关节保留术治疗桡骨远端CampanacciⅢ级骨巨细胞瘤的效果

Efficacy of neoadjuvant denosumab combined with joint-preserving surgery for Campanacci grade Ⅲ giant cell tumor of the distal radius

摘要

目的 探讨地舒单抗新辅助治疗联合关节保留手术治疗桡骨远端CampanacciⅢ级骨巨细胞瘤（GCTB）患者的临床疗效。方法 回顾性分析2019年3月至2023年12月南京大学医学院附属金陵医院骨科收治的经病理确诊的桡骨远端GCTB患者共13例临床资料，所有患者术前应用地舒单抗新辅助治疗（地舒单抗120 mg，皮下注射，4周/次，首月第8天和第15天分别追加1次），后行扩大性病灶刮除术及骨水泥填充内固定术。评估并记录患者一般情况、手术并发症、腕关节活动度以及Mayo评分、肌肉骨骼肿瘤协会（MSTS）评分、视觉模拟评分（VAS）。对患者术前、术后各功能评分采用配对样本t检验进行统计分析。结果 术前患者腕关节屈曲21.3°±5.6°、伸展29.2°±8.6°，旋前32.9°±9.2°，旋后31.4°±6.0°；术前Mayo腕关节功能评分为（25.6±2.9）分，MSTS评分为（51.6±4.2）分，VAS为（5.1±0.6）分。随访中位时间为28.0（23.0，38.5）个月。末次随访时腕关节屈曲（47.6°±7.9°）、伸展（47.5°±9.9°）、旋前（66.5°±11.7°）、旋后（57.4°±8.7°）。Mayo评分（66.9±6.1）分、MSTS评分（73.8±7.4）分较术前明显升高，VAS评分（1.7±0.4）分较术前明显降低，差异均有统计学意义（t_Mayo评分=19.31，t_MSTS评分=7.61，t_VAS=−15.04；P<0.001）；关节保留率为100%，复发率为15.3%。术后并发症发生率为30.8%，主要表现为轻度术后腕部钝痛，无需额外干预，不影响功能恢复。结论 地舒单抗新辅助治疗能够提高桡骨远端CampanacciⅢ级GCTB的骨结构稳定性，并且联合扩大刮除术可有效保留关节功能，术后复发率较低，可改善患者腕关节功能，具有较好的短期疗效。

Abstract

Objective To investigate the clinical efficacy of neoadjuvant denosumab therapy combined with joint-preserving surgery in the treatment of patients with Campanacci grade Ⅲ giant cell tumor of bone (GCTB) of the distal radius. Methods A retrospective analysis was performed on the clinical data of 13 patients with pathologically confirmed GCTB of the distal radius admitted to Department of Orthopedics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, from March 2019 to December 2023. All patients received neoadjuvant denosumab therapy preoperatively (120 mg denosumab subcutaneously every 4 weeks, with additional doses on days 8 and 15 of the first month), followed by extended curettage, bone cement filling and internal fixation. The general conditions, surgical complications, wrist range of motion, Mayo wrist score, musculoskeletal tumor society (MSTS) score and visual analog scale (VAS) were evaluated and recorded. Preoperative and postoperative functional outcomes were compared using the paired t test. Results Preoperatively, the wrist flexion was 21.3°±5.6°, extension was 29.2°±8.6°, pronation was 32.9°±9.2°, and supination was 31.4°±6.0°; the preoperative Mayo wrist score was (25.6±2.9) points, MSTS score was (51.6±4.2) points, and VAS score was (5.1±0.6) points. The median follow-up time was 28.0 (23.0, 38.5) months. At the last follow-up, the wrist flexion was (47.6°±7.9°), extension was (47.5°±9.9°), pronation was (66.5°±11.7°), and supination was (57.4°±8.7°); the Mayo score (66.9±6.1) points and MSTS score (73.8±7.4) points were significantly higher than those preoperatively, while the VAS score (1.7±0.4) points was significantly lower than that preoperatively, with statistically significant differences (t_Mayo=19.31, t_MSTS=7.61, t_VAS=−15.04; P<0.001). The joint preservation rate was 100%, and the recurrence rate was 15.3%. The incidence of postoperative complications was 30.8%, mainly manifested as mild postoperative wrist dull pain, which did not require additional intervention and did not affect functional recovery. Conclusions Neoadjuvant denosumab therapy can improve the bone structural stability of Campanacci grade Ⅲ GCTB of the distal radius. Combined with extended curettage, it can effectively preserve joint function, get a low postoperative recurrence rate and improve wrist function of patients, with favorable short-term efficacy.

关键词

骨巨细胞瘤 / 肿瘤辅助疗法 / 地舒单抗 / 桡骨远端 / 关节保留

Key words

Giant cell tumor of bone / Neoadjuvant therapy / Denosumab / Distal radius / Joint preservation

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基金资助

国家自然科学基金资助项目(82373153)

江苏省自然科学基金面上项目(BK20231505)

东部战区总医院临床研究专项项目(22LCYY-XH1)