Construction Of Clinical Score System And The Related Research Of Diagnosis And Treatment In Pelvis Giant Cell Tumors

Giant cell tumor(GCT)of bone is a common primary bone tumor characterized by its locally aggressive behavior and potential malignant.It accounts 3-8 percent of all primary bone tumors.GCT is usual in the epiphyseal location especially around the knee while pelvis GCT with low incidence accounting for about 1.5-6.1 percent.GCT has benign cytology and malignant biological behavior which lead to high recurrence rate and possible distant metastasis.If the treatment is conservative,incomplete tumor resection and local recurrence is usual.If the treatment is radical,wide resection and unnecessary tissue sacrifice is common.Therefore,it is important to clinicians with a correct understanding of GCT,appropriate treatment choosen and balance between tumor resection and remained limb function.The treatment of pelvic GCT is a challenge for the complicated pelvic anatomy and important biomechanical function in addition to the described characteristics of GCT.Dueing to the low incidence of pelvic GCT,treatment experience of pelvic GCT is lack in literature.There has no guildline,consensus and preoperative assessment system of pelvic GCT treatment.The purpose of this study include three parts.(1)To explore the clinical treatment strategy of pelvic GCT basing on retrospective analysis of multi-center pelvic GCT clinical cases.(2)To establish a clinical score system of pelvic GCT and verify it by retrospective investigation of the patients with pelvic GCT.(3)To explore tumor tissue biomarkers and serum protein diagnostic model of pelvic GCT.Retrospective analysis of pelvic GCT included 29 cases who accepted surgical treatment from 5 clinical centers during the last 12 years.All patients were divided into 3 groups according to tumor locations and they were also classified into 2 groups in light of surgical treatments.The parameters for outcome evaluation consisting of general condition,surgical complications,local disease control and Musculoskeletal Tumor Society(MSTS)93 functional score had been analyzed respectively.Expert consultation method and the analytic hierarchy process were used to eastablish score system of pelvic GCT.Some important primary and secondary indexes were selected from many factors that influenced the decision-making and prognosis of pelvic GCT treatment.A total of 38 patients with pelvic GCT were enrolled in the study from six bone tumor treatment centers from January 2000 to December 2013.Each patient accepeted scoring using the pelvic GCT score system.All patients were divided into 3 groups according to scoring.All the data were compared between these groups which used to certify the accuracy of the scoring system.The tumor tissue samples and serum samples were collected from pelvic GCT patients.MALDI molecular imaging of tumor tissue sections and normal tissue were performed.Serum proteomics were compared beween patients of pelvic GCT and healthy controls by matrix Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry(MALDI-TOF MS).Multi-center retrospective study of pelvic GCT showed that surgical treatment in the acetabular area usually resulted in postoperative complications and poor function.One patient accepted intralesional surgery and two accepted wide resection had local recurrence.The mean functional score was 25.4 for the 8 patients received intralesional surgery and 21.9 for the 21 patients received wide resection.Surgical complications occurred in 1 patient underwent intralesional surgery and other 6 patients underwent wide resection.The GTOC pelvic GCT clinical scoring system was established basing on expert consultation and analytic hierarchy process.The four important indicators included tumor location,tumor size,soft tissue mass and pelvic ring continuity.There were three secondary indicators in each important indicator.For tumor location,the tumor in ilium or ischio-pubic area could get one point,the tumor in acetabulum could get two points,and the tumor involving the above two areas could get three points.For tumor size,in the X-ray film of standard pelvic anteroposterior,nine sub-grid was used for half of the pelvis,the tumor size in one grid could get one point,the tumor size in two grid could get two points and what exceed two grid could get three points.For soft tissue mass,no soft tissue mass could get one point,the soft mass occurring only on one side could get two points,and the soft mass occurring on two side could get three points.For pelvic ring continuity,the normal continuity could get one point,continuity failure occurring in a non-weight-bearing area could get two points,and continuity failure occurring in a weight-bearing area could get three points.For these thirty-eight patients with an average point 7.8(4-12),there were 12 patients scoring 4-6 points,17 patients scoring 7-9 points,and 9 patients scoring 10-12 points.No obvious difference was found in the three scoring groups including gender,age,age composition,resection method and follow-up time.There were some statistical differences in the three scoring groups including resection method,reconstruction,recurrence,complications and MSTS functional score.Four mian protein peaks whose molecular mass were 3198.437 Da,3329.489 Da,3904.425 Da,and 4747.853 Da were detected in the MALDI molecular imaging comparing pelvic GCT tumor tissue and normal tissue.In this study,weak cation exchange beads,hydrophobic beads and copper ion chelate beads were used.Twevle mian protein peaks whose molecular mass were 4209 Da,5904Da,7764 Da,9285Da,5904 Da,1466Da,3263 Da,4209Da,7764 Da,4371Da,4209 Da,and 9285 Da were detected in serum samples protein mass spectrum.We conclude that surgical treatment of pelvic GCTs in the acetabular area is difficult to select as it is always accompanied by complications and poor function.Compared to wide resection,Intralesional surgery combined with a meticulous preoperative planning may lower the recurrence rate and obtain favorable postoperative functional results.Pelvic bone giant cell tumor clinical scoring system covers the main factors affecting the pelvic bone giant cell tumor treatment options and prognosis estimation,there is a guiding role in clinical prognosis and tumor therapy.MALDI molecular imaging and MALDI-TOF MS serum protein profiling are effective methods in detecting tissue biopsies and serum differential proteins of pelvic GCT.