수부/족부 건초에서 발생한 거대 세포종의 재발과 관련된 예후 인자

Abstract

Purpose: Giant cell tumor of the tendon sheath are the most common tumors after ganglionic cysts in benign soft tissue tumors which could be recurred after surgical resection. We evaluate the clinical characteristics of giant cell tumor of the tendon sheath and follow-up results after surgical resection, especially prognostic factors associated with recurrence. Materials and Methods: We reviewed the medical records of patients who were diagnosed Giant cell tumor of the tendon sheath after surgical resection from January 1, 2011 to December 31, 2015. Age, sex, site, side, involved tendon, symptom duration, specific symptoms, size measured by preoperative MRI, operation field findings, operation method, fellow-up duration, and recurrence were analyzed. Results: Among 65 cases, 39 cases (60%) were frequent among women, and the mean age at diagnosis was 36.8 years (7 ~ 85 years). There were 25 cases in the hand and 40 cases in the foot. In the hand, there were 11 cases on the right and 14 cases on the left, in the foot, 20 cases were the same for both left and right. The flexor tendon (31 cases) was more than the extensor tendon (26 cases), and both the extensor and flexor tendons were involved in 3 cases. Symptom duration ranged from 1 to 50 months (mean 17.1 months). Related symptoms include tenderness in 22 cases, edema in 34 cases, limitation of range of motion in 24 cases, and neurological symptoms caused by compression by masses in 17 cases. There were 28 cases of fingers and toes, 12 cases of palmar or midfoot, and 25 cases of wrist or ankle. Average length of the long axis was 33.5 mm (15-150 mm) on the magnetic resonance imaging before surgery. There were 8 cases of bone invasion on simple radiography, and recurrence was observed in 5 cases. There were 41 cases (63.1%) with marginal resection (R0 or R1), 24 cases (36.9%) with intra-lesional resection (R2). In 8 cases of invasion of bone, curettage was performed, and in 4 cases (6.2%) of cement filling procedures. The follow-up period ranged from 36 to 87 months (average 54.1 months), with a total of 8 cases with a recurrence rate of 12.3%. Statistical analysis were performed between each variable and dependent variables. As a result of analysis, gender, tenderness, edema, restrict motion, neurologic symptoms caused by compression due to masses, location, bone invasion, curettage and cement filling, operation findings were not statistically significant, and the factors affecting recurrence were tendon (flexor tendon, extensor tendon and both) and surgical option. As a result of performing a logistic regression analysis, on magnetic resonance imaging before surgery, the tumor length increased by 10 mm, the risk of recurrence increased by 1.2 times, and risk of recurrence increased by 14 times compared to the case of invasion by both the flexor and extensor tendons, and intra-lesional resection (R2) increased 7.2 times than marginal marginal resection (R0 or R1). Conclusion: Giant cell tumor of the tendon sheath occur more frequently in women and flexor tendon. The greater the length of the long axis on preoperative MR image, the more invasiveness of both the flexor and extensor tendon, the risk is likely to increase.