背景:骨巨细胞瘤(GCTB)的理想治疗方法仍然存在争议。在病灶内刮除后已引入各种手术佐剂以提高局部控制率。然而,相关研究的结果不一致,尚未达成共识。这项研究的目的是确定术中辅助治疗对减少GCTB的复发有效。
方法:我们对PubMed和Embase电子数据库中发表的文章进行了系统评价和荟萃分析,这些文章评估了有或没有各种手术辅助的病灶内刮治术后GCTB的复发率。两位作者独立评估了所有出版物。使用Stata/MP(17.0版,StataCorpLLC,TX,美国)和审查经理(RevMan,版本5.4.1,Cochrane协作,2020)。集合风险比(RR)用于分析,P值小于0.05被认为具有统计学意义。
结果:本分析包括24项涉及2,579名患者的研究。有或没有高速毛刺(HSB)治疗的患者的总复发率为11.9%(26/218)和47.7%(92/193),分别。肿瘤复发的合并RR为0.33(95%CI:0.22至0.49,P<0.001)。同时,使用或不使用化学佐剂治疗的患者的总复发率为23.5%(77/328)和26.1%(73/280),分别,合并RR为0.84(95%CI:0.63至1.10,P=0.89)。此外,使用或不使用聚甲基丙烯酸甲酯(PMMA)治疗的患者的总复发率为20.4%(205/1,006)和33.4%(314/939),分别,合并RR为0.59(95%CI:0.50至0.69,P<0.001)。
结论:术中应用HSB或PMMA具有额外的抗肿瘤作用,而使用苯酚或H2O2不能产生任何显著差异(PROSPERO:CRD42022344262)。
BACKGROUND: The ideal treatment for giant cell tumor of bone (GCTB) is still controversial. Various surgical adjuvants have been introduced following intralesional
curettage to improve local control rates. However, findings from relevant studies are inconsistent, and no consensus has been reached. The purpose of this study is to determine what intraoperative adjuvant is effective in decreasing the recurrence of GCTB.
METHODS: We performed a systematic review and meta-analysis of articles published in the PubMed and Embase electronic databases which assessed the recurrence rate of GCTB following intralesional
curettage with or without various surgical adjuvants. Two authors independently evaluated all publications. Meta-analysis was performed with Stata/MP (Version 17.0, StataCorp LLC, TX, USA) and Review Manager (RevMan, Version 5.4.1, The Cochrane Collaboration, 2020). Pooled risk ratio (RR) was used for analysis, with P values less than 0.05 considered statistically significant.
RESULTS: Twenty-four studies involving 2,579 patients were included in this analysis. The overall recurrence rates for patients treated with or without high-speed burring (HSB) are 11.9% (26/218) and 47.7% (92/193), respectively. The pooled RR for tumor recurrence is 0.33 (95% CI: 0.22 to 0.49, P<0.001). In the meanwhile, the overall recurrence rates for patients treated with or without chemical adjuvants are 23.5% (77/328) and 26.1% (73/280), respectively, with a pooled RR of 0.84 (95% CI: 0.63 to 1.10, P=0.89). Additionally, the overall recurrence rates for patients treated with or without polymethyl methacrylate (PMMA) are 20.4% (205/1,006) and 33.4% (314/939), respectively, with a pooled RR of 0.59 (95% CI: 0.50 to 0.69, P<0.001).
CONCLUSIONS: Intraoperative application of HSB or PMMA has an additional antitumor effect, while the use of phenol or H2O2 fails to make any significant difference (PROSPERO: CRD42022344262).