Surgical Treatment of Localized-Type Tenosynovial Giant Cell Tumors of Large Joints: A Study Based on a Multicenter-Pooled Database of 31 International Sarcoma Centers

• Published in: Journal of bone and joint surgery. American volume 2019-07, Vol.101 (14), p.1309-1318
• Main Authors: Mastboom, M.J.L., Staals, E.L., Verspoor, F.G.M., Rueten-Budde, A.J., Stacchiotti, S., Palmerini, E., Schaap, G.R., Jutte, P.C., Aston, W., Leithner, A., Dammerer, D., Takeuchi, A., Thio, Q., Niu, X., Wunder, J.S., van de Sande, M.A.J.
• Format: Article
• Language: English
• Subjects: Adult; Arthroscopy; Databases, Factual; Female; Giant Cell Tumor of Tendon Sheath - surgery; Humans; Joint Diseases - surgery; Male; Neoplasm Recurrence, Local; Postoperative Complications; Sarcoma - surgery
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.18.01147

Localized-type tenosynovial giant cell tumor (TGCT) is a rare, neoplastic disease with only limited data supporting treatment protocols. We describe treatment protocols and evaluate their oncological outcome, complications, and functional results in a large multicenter cohort of patients. A secondary study aim was to identify factors associated with local recurrence after surgical treatment. Patients with histologically proven localized TGCT of a large joint were included if they had been treated between 1990 and 2017 in 1 of 31 tertiary sarcoma centers. Of 941 patients with localized TGCT, 62% were female. The median age at initial treatment was 39 years, and the median duration of follow-up was 34 months. Sixty-seven percent of the tumors affected the knee, and the primary treatment at the tertiary center was 1-stage open resection in 73% of the patients. Proposed factors for predicting a first local recurrence after treatment in the tertiary center were tested in a univariate analysis, and those that demonstrated significance were subsequently included in a multivariate analysis. The localized TGCT recurred in 12% of all cases, with local-recurrence-free rates at 3, 5, and 10 years of 88%, 83%, and 79%, respectively. The strongest factor for predicting recurrent disease was a prior recurrence (p < 0.001). Surgical treatment decreased pain and swelling in 71% and 85% of the patients, respectively, and such treatment was associated with complications in 4% of the patients. Univariate and multivariate analyses of the patients who had not undergone therapy previously yielded positive associations between local recurrence and a tumor size of ≥5 cm versus