Prognosis of metastatic giant cell tumor of bone in the pre-denosumab era. A systematic review and a meta-analysis

• Published in: Japanese journal of clinical oncology Vol. 48; no. 7; pp. 640 - 652
• Main Authors: Itkin, Boris, Straminsky, Samanta, De Ronato, Gabriela, Lewi, Daniel, Marantz, Adolfo, Bardach, Ariel
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.07.2018
• Subjects: Adult; Denosumab - therapeutic use; Disease-Free Survival; Female; Giant Cell Tumor of Bone - drug therapy; Giant Cell Tumor of Bone - pathology; Humans; Male; Neoplasm Metastasis; Prognosis; Remission Induction; Retrospective Studies; Lung-Med; Lung-Surg; orthopedics/sarcoma
• ISSN: 1465-3621; 0368-2811; 1465-3621
• DOI: 10.1093/jjco/hyy067

This study brings several prognostic estimates of patients with metastatic giant cell tumor of bone. It circumscribes reference values for an indirect comparison of the efficacy of new drugs. Abstract Background Data on long-term prognosis of metastatic GCT (mGCT) is scant. The frequency of spontaneous regressions (SRs) is unknown. We aimed to estimate the prognosis of mGCT. Methods We searched electronic scientific literature databases and generic Internet from January 1980 to August 2017. After identifying eligible studies we performed descriptive analyses and meta-analyses to estimate overall survival (OS), disease specific survival (DSS) and frequency of SRs in the years before the widespread use of denosumab. We performed pre-specified subgroup analyses of studies published before and after 2000 and of those with more and less than 10 years of follow-up. Results After retrieving and combining data from 26 relevant retrospective case-series totaling 242 patients with a median follow-up of 6.9 years, the estimated pooled OS was 86.9% (95% CI 78.0–94.2). Pooled DSS was 88.0% (95% CI 79.7–94.7). SRs were observed in 4.5% of patients. In the subgroup of studies published after 2000 mGCT was the only cause of death of affected subjects. In case-series with a follow-up longer than 10 years pooled DSS was 69.7% (95% CI 25.5–99.8). Conclusions To our knowledge this is the first study to derive estimated pooled OS and DSS of mGCT based on a large dataset. SRs were not exceptional phenomena. In a long run the disease could impact in a significant way on the life expectancy of affected subjects.