骶骨巨细胞瘤：管理挑战与治疗方式的叙述性综述
Giant Cell Tumor of the Sacrum: A Narrative Review of Management Challenges and Modalities.
摘要(中文译文)
骶骨骨巨细胞瘤（GCTB）是一种罕见的、多为良性但具有局部侵袭性的肿瘤，因其解剖结构复杂、毗邻骶神经根及血管，且可能影响肠道、膀胱、性功能及腰盆功能与稳定性，在诊断和治疗上面临重大挑战。本叙述性综述旨在综合当前关于骶骨GCTB的流行病学、临床表现、诊断评估、分类、治疗策略、结局及监测等方面的证据。研究对PubMed/MEDLINE和Google Scholar进行了聚焦文献检索，纳入2000年1月至2026年1月发表的研究，并额外手动查阅了参考文献列表。鉴于该肿瘤的罕见性以及研究设计、治疗策略和结局方面所观察到的异质性，证据以叙述性方式进行了综合。骶骨GCTB主要影响年轻成人，病程隐匿，常因进行性下腰痛或臀部疼痛、神经根病或神经功能缺损而就诊较晚。磁共振成像是确定局部范围的优选方法，而组织病理学活检和分子检测仍是明确诊断的必要手段。传统分级系统如Enneking和Campanacci分级在骶骨病变中价值有限，因为解剖范围和预期神经功能损害对治疗计划的制定更为相关。手术仍是可切除病变的基石，但治疗方案应权衡局部肿瘤控制与骶神经根保护及机械稳定性之间的关系。地舒单抗、选择性动脉栓塞和放疗可能在部分不可切除或高并发症风险的病例中发挥重要作用。局部复发仍是主要关注的问题，建议进行长期监测，因为肿瘤复发、治疗相关并发症和远处转移可能较晚发生。当前证据支持对骶骨GCTB采取多学科、个体化的治疗策略，以肿瘤范围、预期神经功能损害和以患者为中心的功能结局为指导。需要前瞻性多中心研究来完善治疗算法并改进风险分层。
Abstract
Sacral giant cell tumor of bone (GCTB) is a rare, mostly benign but locally aggressive neoplasm that carries significant diagnostic and treatment challenges due to its anatomic complexity, proximity to sacral nerve roots as well as the blood vessels, and potential impact on bowel, bladder, sexual, and lumbopelvic function and stability. This narrative review aimed to synthesize current evidence on the epidemiology, clinical presentation, diagnostic evaluation, classification, management strategies, outcomes, and surveillance of sacral GCTB. A focused literature search of PubMed/MEDLINE and Google Scholar was conducted for studies published between January 2000 and January 2026, with additional manual review of reference lists. Given the rarity of the tumor and the observed heterogeneity in study designs, treatment strategies, and outcomes, the evidence was synthesized narratively. Sacral GCTB mainly affects young adults with an indolent nature, often presenting late with progressive low back or buttock pain, radiculopathy, or neurological deficits. Magnetic resonance imaging is the preferred modality for determining local extent, whereas histopathologic biopsy and molecular testing remain essential for definitive diagnosis. Conventional grading systems, such as Enneking and Campanacci, have limited value in sacral disease, as anatomical extent and anticipated neurological morbidity are more relevant for treatment planning. Surgery remains the cornerstone for resectable disease, yet management plans should balance local tumor control against preservation of sacral nerve roots and mechanical stability. Denosumab, selective arterial embolization, and radiotherapy may play important roles in selected unresectable or high-morbidity cases. Local recurrence remains a major concern, and long-term surveillance is recommended because tumor relapse, treatment-related morbidity, and distant metastasis may occur late. Current evidence supports a multidisciplinary, individualized approach to sacral GCTB, guided by tumor extent, expected neurological morbidity, and patient-centered functional outcomes. Prospective multicenter studies are needed to refine treatment algorithms and improve risk stratification.
如何引用
AMA
Abdulrahman Alaseem, Zyad A Aldosari, Abdulmalik A Alduraibi, Rola K Alzahrani, Abdulaziz S AlNahari, Motaz AlAqeel, et al. Giant Cell Tumor of the Sacrum: A Narrative Review of Management Challenges and Modalities.. Healthcare (Basel, Switzerland). 2026; doi:10.3390/healthcare14101381.
APA
Abdulrahman Alaseem, Zyad A Aldosari, Abdulmalik A Alduraibi, Rola K Alzahrani, Abdulaziz S AlNahari, Motaz AlAqeel, et al (2026). Giant Cell Tumor of the Sacrum: A Narrative Review of Management Challenges and Modalities.. Healthcare (Basel, Switzerland). https://doi.org/10.3390/healthcare14101381
GB/T 7714
Abdulrahman Alaseem, Zyad A Aldosari, Abdulmalik A Alduraibi, Rola K Alzahrani, Abdulaziz S AlNahari, Motaz AlAqeel, et al. Giant Cell Tumor of the Sacrum: A Narrative Review of Management Challenges and Modalities.[J]. Healthcare (Basel, Switzerland), 2026 doi:10.3390/healthcare14101381.
在 PubMed增强版 阅读全文
翻译全文 · AI 文献问答 · PDF 原文下载 · 引用导出