骨巨细胞瘤多学科管理的进展：从手术到全身治疗

Advances in Multidisciplinary Management of Giant Cell Tumor of Bone: From Surgery to Systemic Therapy

摘要: 骨巨细胞瘤是一种良性肿瘤，最常侵犯膝关节等负重骨骼。其典型的临床表现包括疼痛、肿胀以及受累肢体无法承重。在组织学上，多核巨细胞是该病的特征性标志，易于通过组织学检查识别，并成为治疗的主要靶点。长期以来，手术一直是骨巨细胞瘤的主要治疗方式。近年来，治疗策略进一步优化，通过切除病灶并用骨水泥或异体骨移植填充骨缺损，可有效降低局部复发风险(低至中等水平)，同时保留肢体功能。对于更具破坏性的肿瘤，通常采用大范围切除，并结合假体、结构性异体骨或两者联合的重建技术进行修复。然而，骨巨细胞瘤的管理仍面临一大难题：对于晚期病例，单纯手术可能导致较高的发病率。因此，目前的治疗已从局部治疗转向多学科管理，积极引入地诺单抗和双膦酸盐类药物作为辅助治疗手段。

Abstract: Giant cell tumor of bone (GCTB) is a benign tumor that most commonly affects weight-bearing bones such as the knee. Its typical clinical manifestations include pain, swelling, and the inability of the affected limb to bear weight. Histologically, multinucleated giant cells are characteristic of the disease, easily identifiable through tissue examination, and serve as the primary therapeutic target. Surgery has long been the main treatment for GCTB. In recent years, treatment strategies have been optimized, with resection of the lesion followed by bone cement or allograft bone transplantation to fill the bone defect, effectively reducing the risk of local recurrence (from low to moderate levels) while preserving limb function. For more destructive tumors, extensive resection is typically performed, followed by reconstruction using prosthetics, structural allografts, or a combination of both. However, the management of GCTB still faces a major challenge: for advanced cases, simple surgery may result in higher morbidity. As a result, treatment has shifted from localized therapy to multidisciplinary management, with the active incorporation of denosumab and bisphosphonates as adjunctive treatments.