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Review
. 2025 Feb 8:51:100663.
doi: 10.1016/j.jbo.2025.100663. eCollection 2025 Apr.

Comparative analysis of aggressiveness in giant cell tumor of bone between upper and lower extremities: A systematic review and meta-analysis

Rhyan Darma Saputra  1 , Dita Anggara Kusuma  2 , Fathih Kaldani  2 , Khoirul Fahmi  2
Affiliations
Review

Comparative analysis of aggressiveness in giant cell tumor of bone between upper and lower extremities: A systematic review and meta-analysis

Rhyan Darma Saputra et al. J Bone Oncol. .

Abstract

Background and objective: Giant cell tumor of bone (GCTB) is among the most prevalent benign primary bone tumors, characterized by its potential for aggressive local recurrence, soft tissue invasion, and, though rare, lung metastasis. Emerging evidence suggests unique behavioral patterns of GCTB in extremities. This study seeks to rigorously compare the aggressiveness of GCTB in the upper versus lower extremities, centering on recurrence rates.

Method: This systematic review and meta-analysis, conducted in accordance with PRISMA guidelines, sourced data from MEDLINE/PubMed, Cochrane, Scopus, CINAHL/EBSCO, and reference lists of pertinent studies. Two independent reviewers screened studies, with discrepancies resolved by discussion. Eligible studies included a minimum of 10 participants. Data extraction and analysis were performed by an additional team of two researchers.

Results: Out of 1,283 studies spanning from 1984 to 2023, 30 met eligibility, encompassing 2,672 participants. The mean age was 32.77 ± 12.99 years, with an average follow-up of 75.53 ± 65.88 months. GCTB predominantly affected the lower extremities, accounting for 1,937 cases. Notably, comparisons of aggressiveness between upper and lower extremity GCTB revealed no statistically significant difference (OR = 1.10, p = 0.56 for Surgery Group; OR = 1.16, p = 0.45 for Local Adjuvant Group; and OR = 1.71, p = 0.32 for Drug/Denosumab Group).

Conclusion: This analysis underscores the lower extremities as the primary site for GCTB but finds no significant difference in aggressiveness between upper and lower extremities. These findings challenge assumptions about GCTB behavior based on tumor location and highlight the need for further investigation to fully elucidate the complex biology of extremity GCTB.

Keywords: Aggressiveness; Giant cell tumor of bone (GCTB); Lower Extremity; Recurrence; Upper Extremity.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

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Graphical abstract
Fig. 1
Fig. 1
PRISMA diagram of study selection.
Fig. 2
Fig. 2
Meta analysis results of surgery subgroup.
Fig. 3
Fig. 3
Meta analysis results of local adjuvant subgroup.
Fig. 4
Fig. 4
Meta analysis results of drug therapy subgroup.
Fig. 5
Fig. 5
Meta analysis results of metastasis events.
Fig. 6
Fig. 6
Meta analysis results of aggressiveness comparison based on grade III tumor.
Fig. 7
Fig. 7
Meta analysis results of MSTS Score comparison.
See this image and copyright information in PMC

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