Desfechos pós-operatórios com ou sem denosumabe adjuvante em tumores de células gigantes de grau III do fêmur proximal: Um estudo retrospectivo comparativo

Resumo

Objetivo

Comparar retrospectivamente o impacto do uso de denosumabe neoadjuvante em tumores de células gigantes (TCG) de grau III de Campanacci no fêmur proximal com acometimento da articulação do quadril.

Métodos

Avaliamos retrospectivamente 18 casos de TCG de grau III de Campanacci do fêmur proximal que foram submetidos à cirurgia entre janeiro de 2014 e dezembro de 2019 em nosso hospital. Um grupo de 10 pacientes receberam denosumabe neoadjuvante em dose de 120 mg uma vez por semana por 4 semanas, enquanto outro grupo, com 8 pacientes, não recebeu denosumabe antes da cirurgia. Dois pacientes foram submetidos à curetagem intralesional e os demais, à ressecção e artroplastia de quadril. As comparações foram feitas usando o teste t não pareado e o teste exato de Fisher. Os resultados funcionais foram avaliados pelo escore revisto da Musculoskeletal Tumor Society (MSTS) e pelo escore de quadril de Harris (Harris Hip Score, HSS) em 6 semanas, 6 meses e 12 meses de acompanhamento. A incidência de recidiva também foi determinada.

Resultados

A comparação das médias dos escores MSTS entre os grupos com e sem denosumabe foi de 24,0 ± 6,5 versus 20,0 ± 6,0 (p = 0,04) em 6 semanas, respectivamente; 26,0 ± 5,0 versus 23,0 ± 0,67 (p = 0,04) em 6 meses, respectivamente; e 28,8 ± 1,7 versus 29,5 ± 0,33 (p = 0,35) em 12 meses, respectivamente. A comparação das médias das pontuações no HSS entre os grupos com e sem denosumabe foi de 61,02 ± 7,36 versus 48,52 ± 3,97 (p = 0,03) em 6 semanas, respectivamente; 81,1 ± 2,97 versus 79,15 ± 3,24 (p = 0,82) em 6 meses, respectivamente; e 89,84 ± 3,75 versus 90,05 ± 3,00 (p = 0,38) em 12 meses, respectivamente. Não houve recidiva.

Conclusão

O denosumabe foi clinicamente eficaz na melhora dos desfechos funcionais em curto prazo, mas os desfechos funcionais em longo prazo foram semelhantes entre ambos os grupos. Não observamos aumento na taxa de recidiva no grupo com denosumabe.

Abstract

Objective

To retrospectively compare the impact of using neoadjuvant denosumab for Campanacci grade-III giant cell tumor (GCT) of the proximal femur involving the hip joint.

Methods

We retrospectively reviewed 18 cases of Campanacci grade-III GCT of the proximal femur receiving surgery between January 2014 and December 2019 from our hospital. One group of 10 patients received weekly neoadjuvant denosumab 120 mg for 4 weeks, while the other group of 8 patients did not receive denosumab before surgery. Two patients were subjected to intralesional curettage while the others received resection and hip arthroplasty. Comparisons were made using unpaired t-test and Fisher's exact test. Functional outcomes were assessed by revised Musculoskeletal Tumor Society (MSTS) score and Harris Hip Score (HHS) at 6 weeks, 6 months, and 12 months of follow-up, as well as incidence of recurrence.

Results

The comparison of the mean MSTS scores of the denosumab and non-denosumab groups was as follows: 24.0 ± 6.5 versus 20.0 ± 6.0 (p = 0.04) at 6 weeks respectively; 26.0 ± 5.0 versus 23.0 ± 0.67 (p = 0.04) at 6 months respectively; and 28.8 ± 1.7 versus 29.5 ± 0.33 (p = 0.35) at 12 months respectively. The comparison of HHSs between the denosumab and non-denosumab groups was as follows: 61.02 ± 7.36 versus 48.52 ± 3.97 (p = 0.03) at 6 weeks respectively; 81.1 ± 2.97 versus 79.15 ± 3.24 (p = 0.82) at 6 months respectively; and 89.84 ± 3.75 versus 90.05 ± 3.00 (p = 0.38) at 12 months respectively. There was no recurrence.

Conclusion

Denosumab was clinically effective in improving the short-term functional outcomes, but long-term functional outcomes remained similar between the groups. We did not find an increased recurrence rate in the denosumab group.

Palavras-chave

denosumabe - fraturas proximais do fêmur - neoplasias ósseas - quadril - tumores de células gigantes

Keywords

bone neoplasms - denosumab - giant cell tumor - hip - proximal femoral fractures

Contribuições dos Autores

Cada autor contribuiu individual e significativamente para o desenvolvimento deste artigo: MUA e SMEA: concepção, coleta de dados, redação – revisão & edição, delineamento experimental, interpretação de dados, e redação – preparação do original; e HK e AA: delineamento experimental, interpretação de dados, e redação – preparação do original. Todos os autores aprovaram o manuscrito final e são responsáveis pela validade dos dados.

Estudo desenvolvido no Departamento de Traumatologia e Ortopedia, Dr. Ruth KM Pfau Civil Hospital, Karachi, Paquistão.

Publikationsverlauf

Eingereicht: 11. September 2024

Angenommen: 13. März 2025

Artikel online veröffentlicht:
10. Juli 2025

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