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目的分析影响骨巨细胞瘤(giant cell tumor,GCT)术后复发的预后相关因素。方法回顾性分析1990—2003年收治的146例骨巨细胞瘤患者的临床资料,采用单因素χ2分析性别、年龄、影像学Campanacci分级、病理学Jaffe分级、手术方式、局部处理、发病时间等13项临床因素与GCT复发的关系,并分析Campanacci分级和Jaffe分级的相关性。多因素分析采用Logistic回归分析。结果146例患者获得随访,随访时间24~180个月,平均58个月。本组共19例复发,总复发率为13·0%,局部刮除和瘤段切除后复发率分别为18·8%和6·3%,单纯刮除和扩大刮除复发率分别为38·9%和12·9%。肺转移5例,恶变2例,转移率和恶变率分别为3·4%、1·4%。单因素分析显示肿瘤突破包壳、手术方式(单纯刮除、扩大刮除、瘤段切除)与GCT复发具有相关性,多因素Logistic回归分析显示手术方式是影响复发的重要因素。影像学分级和病理学分级与肿瘤复发不具有相关性。结论手术方式、肿瘤突破包壳与GCT复发相关,手术方式是影响复发的关键因素。
Objective To analyze the prognostic factors influencing the recurrence of giant cell tumor (GCT). Methods The clinical data of 146 patients with giant cell tumor of bone (GCT) treated in 1990-2003 were retrospectively analyzed. The data were analyzed by single factor χ2 analysis of sex, age, radiographic Campanacci classification, pathological Jaffe classification, operation method, topical treatment and onset time. Term clinical factors and GCT recurrence, and analyze the correlation between Campanacci classification and Jaffe classification. Multivariate analysis using Logistic regression analysis. Results 146 patients were followed up for 24 to 180 months with an average of 58 months. The group of 19 cases of recurrence, the total recurrence rate was 13.0%, local curettage and tumor resection recurrence rates were 18.8% and 6.3%, simple curettage and curettage recurrence rates were 38 · 9% and 12.9%. 5 cases of lung metastasis and 2 cases of malignant transformation. The rates of metastasis and malignant transformation were 3.4% and 1.4% respectively. Univariate analysis showed that the tumor broke through the enclosure. The surgical methods (simple curettage, extended curettage, tumor resection) were correlated with the recurrence of GCT. Multivariate Logistic regression analysis showed that the operative method was an important factor affecting recurrence. Imaging grade and pathological grade had no correlation with tumor recurrence. Conclusion The operation method, the tumor breakout envelope and the recurrence of GCT are related. The surgical method is the key factor that affects the recurrence.