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Background <p>Advancements in diagnostic and therapeutic modalities for giant cell tumors of bone (GCTB) have introduced molecular and radiological tools that refine clinical decision-making. H3.3 G34W immunohistochemical staining has become a routine diagnostic marker, while H3F3A mutational analysis enhances prognostic insights. Treatment primarily involves surgical methods such as curettage or en bloc resection, with denosumab serving as an adjunct in high-risk or inoperable cases.</p> Methods <p>We retrospectively analyzed 55 patients with GCTB, focusing on clinicopathologic and radiological findings. Tumors were evaluated using the Campanacci grading system. Immunohistochemical analysis with H3.3 G34W antibody and next-generation sequencing (NGS) were performed to detect H3F3A mutations. A subgroup of nine patients treated with denosumab was further analyzed for clinical outcomes and histological changes.</p> Results <p>The cohort had a mean age of 37.7 years, with tumors most commonly affecting the knee joint (55%). All tested tumors demonstrated positive H3.3 G34W staining, with eight exhibiting H3F3A G34W mutations. Recurrence rates were 32% following curettage and 18% after en bloc resection. Denosumab treatment, administered for an average of 14.6 months, facilitated tumor downsizing and new bone formation without major side effects. Histologically, treated tumors showed a depletion of giant cells and increased bone matrix deposition.</p> Conclusions <p>Surgery remains the cornerstone of GCTB treatment, with curettage or resection tailored to tumor characteristics. Denosumab offers a valuable adjunct in high-risk cases, enhancing surgical feasibility and promoting joint preservation. The Campanacci grading system continues to be a crucial tool for prognostication and treatment planning, particularly when complemented by molecular and radiological diagnostics. Future research should focus on integrating advanced imaging and artificial intelligence for personalized GCTB management.</p> <p><i>Level of evidence:</i> Level 4</p>

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Surgical and radiological outcomes of giant cell tumor of the bone: prognostic value of Campanacci grading and selective use of denosumab

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年5月3日

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  • Jasminka Igrec,
  • Lisa Jernej,
  • Maria Anna Smolle,
  • Jakob Steiner,
  • Susanne Scheipl,
  • Birgit Lohberger,
  • Andreas Leithner,
  • Iva Brcic

摘要

Background

Advancements in diagnostic and therapeutic modalities for giant cell tumors of bone (GCTB) have introduced molecular and radiological tools that refine clinical decision-making. H3.3 G34W immunohistochemical staining has become a routine diagnostic marker, while H3F3A mutational analysis enhances prognostic insights. Treatment primarily involves surgical methods such as curettage or en bloc resection, with denosumab serving as an adjunct in high-risk or inoperable cases.

Methods

We retrospectively analyzed 55 patients with GCTB, focusing on clinicopathologic and radiological findings. Tumors were evaluated using the Campanacci grading system. Immunohistochemical analysis with H3.3 G34W antibody and next-generation sequencing (NGS) were performed to detect H3F3A mutations. A subgroup of nine patients treated with denosumab was further analyzed for clinical outcomes and histological changes.

Results

The cohort had a mean age of 37.7 years, with tumors most commonly affecting the knee joint (55%). All tested tumors demonstrated positive H3.3 G34W staining, with eight exhibiting H3F3A G34W mutations. Recurrence rates were 32% following curettage and 18% after en bloc resection. Denosumab treatment, administered for an average of 14.6 months, facilitated tumor downsizing and new bone formation without major side effects. Histologically, treated tumors showed a depletion of giant cells and increased bone matrix deposition.

Conclusions

Surgery remains the cornerstone of GCTB treatment, with curettage or resection tailored to tumor characteristics. Denosumab offers a valuable adjunct in high-risk cases, enhancing surgical feasibility and promoting joint preservation. The Campanacci grading system continues to be a crucial tool for prognostication and treatment planning, particularly when complemented by molecular and radiological diagnostics. Future research should focus on integrating advanced imaging and artificial intelligence for personalized GCTB management.

Level of evidence: Level 4