Surgery Yields High Risk for Recurrence, Complications in Patients With TGCTs

Findings from a recent clinical study of patients with diffuse-type tenosynovial giant-cell tumors show that surgery is not a definitive treatment for every patient with this disease because the procedure yields high risks for local recurrent disease and postoperative complications (Lancet Oncol. 2019 Apr 24. Epub ahead of print).

“Diffuse-type tenosynovial giant-cell tumour is a rare, locally aggressive, and difficult-to-treat soft tissue tumour. Clinical and surgical outcomes depend on multiple factors, including preoperative diagnostic assessment, the localisation and extent of disease, and possibly the choice of treatment modalities by orthopaedic surgeons,” said lead investigator Monique J. L. Mastboom, MD, Department of Orthopaedics, Leiden University Medical Center, The Netherlands, and colleagues.

“We did a retrospective cohort study to characterise global surgical treatment protocols, and assess surgical outcomes, complications, and functional results in patients with diffuse-type tenosynovial giant-cell tumours,” they explained.

Data from 1192 patients with diffuse-type tenosynovial giant-cell tumor of large joints was collected between January 2016 and May 2018 from the databases of 31 participating sarcoma reference centers. Only patients with complete core criteria data regarding admission status, date of therapy, type of treatment, and first local recurrence posttreatment were included in the study; those with localized-type tenosynovial giant-cell tumor were excluded.

“We used a non-parametric method to estimate recurrence-free survival at 3, 5, and 10 years after initial surgical resection in a tertiary centre…[and]…a multivariate Cox regression model to estimate the effect of risk factors,” noted Dr Mastboom et al.

“We also present subgroup analyses of disease status at presentation (primary vs recurrent disease) and recurrence-free survival by surgery type (open surgery vs arthroscopic synovectomy), and prespecified risk factors were tested in a univariate and multivariable analyses, with an endpoint of first local recurrence after treatment in a tertiary centre,” they added.

Approximately 80% (n = 966) of patients underwent surgery and had complete information on core criteria; 445 patients were admitted with therapy-naive disease of the knee and received primary treatment at a tertiary center.

Patients without a treatment start date (ie, those receiving wait and see treatment) were excluded from calculation of the median follow-up time for all patients. Overall, 758 (64%) patients had knee involvement, and of 1163 patients with complete data on type of surgery, 628 (54%) had 1-staged open synovectomy.

The median follow-up was 54 months, at which point 425 (44%) of all 966 patients who underwent surgery had recurrent disease. At 3, 5, and 10 years, recurrence-free survival was 62% (95% CI, 59-65), 55% (95% CI, 51-58), and 40% (95% CI, 35-45), respectively.

Among 906 patients who had complete data on surgical complications, 105 (12%) had surgical complications. Of note, pain improved postsurgery in 255 (59%) of 434 patients, and swelling improved in 328 (72%) of 453 patients who had complete data.

“Surgical treatment of diffuse-type tenosynovial giant cell tumours is not a definitive treatment for every patient because it involves a high risk for local recurrent disease and a relatively high risk for postoperative complications,” Dr Mastboom and colleagues said.

“After surgical treatment in treatment-naive patients, risk factors for recurrent disease in individual patients were not identified in what we believe is the largest cohort to date,” they concluded.—Hina Khaliq