| 杨毅,郭卫,杨荣利,等.地诺单抗联合手术治疗桡骨远端骨巨细胞瘤——外科降级及预后.骨科,2018,9(1): 1-6. |
| 地诺单抗联合手术治疗桡骨远端骨巨细胞瘤——外科降级及预后 |
| Surgical downstaging and prognosis in a retrospective cohort study of perioperative treatment with Denosumab in patients with giant cell tumor on distal radius |
| 投稿时间：2017-12-25 |
| DOI：10.3969/j.issn.1674-8573.2018.01.001 |
| 中文关键词: 骨巨细胞瘤 核因子κB活化剂受体配体 地诺单抗 桡骨 |
| 英文关键词: Giant cell tumor of bone Receptor activator of the nuclear factor kappa B ligand Denosumab Radius |
| 基金项目:首都临床特色应用研究与成果推广（Z151100004015169） |
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| 中文摘要: |
| 目的 评估地诺单抗治疗桡骨远端骨巨细胞瘤（giant cell tumor of bone, GCT）的疗效和安全性，分析地诺单抗对手术方式及预后的影响。方法 回顾性分析2014年1月至2016年4月，在围手术期接受地诺单抗治疗的复杂桡骨远端GCT病人7例的临床资料。其中，男4例，女3例；年龄为23~33岁，平均28.43岁。所有病人均有明确GCT病理诊断，2例为手术后复发。病人术前接受120 mg 地诺单抗皮下注射3~4次，术后根据实际手术类型安排用药。比较病人应用地诺单抗前后手术方案的差异，监测用药过程中的不良反应；随访病人的肿瘤学预后及术后功能恢复。结果 病人均按计划用药，用药总次数为4~10次（平均7.71次），用药期间无死亡病例，未见下颌骨坏死，实验室指标未见异常，RECIST评估结果显示：部分缓解5例、疾病稳定2例；6例病人（85.71%）实现外科手术降级（行囊内刮除术5例，瘤段广泛切除2例），术后病理结果提示组织学巨细胞清除率为85.71%（6/7）；随访20~41个月，平均26.71个月，7例病人随访期内均未见肿瘤复发；病人术后的肌肉骨骼肿瘤学会（MSTS）93功能评分平均为27.86分（得分率为92.87%），平均臂肩手功能障碍（DASH）评分为7.43分，平均疼痛视觉模拟量表（VAS）评分为1.00分。结论 地诺单抗是治疗桡骨远端GCT的有效手段，围手术期用药可降低手术难度，从而实现外科降级并降低复发风险。 |
| 英文摘要: |
| Objective To evaluate the efficacy and safety of denosumab for the treatment of giant cell tumor of bone (GCT), and analyze the impact of the mode of operation and prognosis. Methods From January 2014 to April 2016, data of 7 patients with complex radius GCT who were treated with denosumab during perioperative period were retrospectively analyzed. There were 4 male and 3 female. The average age was 28.43 years old (23-33 years). All patients had a definite pathological diagnosis of GCT, and 2 cases had a recurrence after the first operation. The patients were given subcutaneous injection of 120 mg denosumab 3-4 doses preoperative, and the medication was arranged according to the actual type of operation after operation. The difference of the patients before and after the application of denosumab, and the adverse events in the process of treatment were observed. The prognosis of oncology and postoperative function were followed up. Results All patients received Denosumab preoperatively and/or postoperatively according to schedule, 4~10 doses (mean 7.71 doses), no death, no mandibular necrosis, and laboratory indexes were not abnormal. The results of RECIST: partial remission in 5 cases and stable disease in 2 cases. Six patients (85.71%) achieved surgical downstaging, the pathological results showed that histological cell clearance rate was 85.71% (6/7). They were followed-up for 20-41 months, with an average of 26.71 months, no tumor recurrence. The average MSTS93 score of the patients was 27.86 (92.87%), the average DASH score was 7.43, and the average VAS score was 1. Conclusion For patients with GCT of distal radius, neoadjuvant denosumab therapy resulted in beneficial surgical downstaging, including a less morbid surgical procedure and lower recurrence. |
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