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Background <p>Tenosynovial giant cell tumor (TGCT) is a common benign soft-tissue neoplasm, typically occurring in joints such as the hand, foot, and knee. However, the heterogeneity in biological behavior across different anatomical locations—particularly between weight-bearing and non-weight-bearing joints—remains to be elucidated. This study aimed to analyze the anatomical distribution characteristics of extremity TGCT, evaluate surgical outcomes and recurrence-associated factors, explore the prognostic significance of key molecular markers (specifically Ki-67), and assess postoperative quality of life using patient-reported outcome measures (PROMs).</p> Methods <p>This single-center retrospective study included 82 patients with TGCT of the extremities treated between July 2017 and January 2025. Cases were classified into localized (L-TGCT) and diffuse (D-TGCT) types based on growth patterns and histological findings. Ki-67 expression was analyzed across the entire cohort. The Ki-67 labeling index was dichotomized into low-expression (&lt; 10%) and high-expression (≥ 10%) groups based on a 10% cutoff value derived from previously established prognostic criteria in relevant literature. Recurrence-free survival (RFS) was estimated using the Kaplan-Meier method, and risk factors were identified via multivariable Cox proportional hazards regression. The proportional hazards assumption was verified. PROMs included MSTS-93, NRS, BPI, and PROMIS scales.</p> Results <p>The mean age was 39.9 ± 12.8 years. Distribution included 30 hand (36.6%), 27 foot (32.9%), and 25 knee (30.5%) cases. The mean follow-up was 4.8 years. The overall recurrence rate was 30.5% (25/82), with 4 recurrences in the hand, 10 in the foot, and 11 in the knee. Multivariable Cox analysis showed that invasive bone involvement (HR=4.21, <i>p</i>=0.007) and Ki-67 ≥10% (HR=3.52, <i>p</i>=0.021) were independent risk factors for recurrence. All PROMs significantly improved at 6 months postoperatively.</p> Conclusion <p>TGCT exhibits significant biological heterogeneity. A Ki-67 index ≥10% and invasive bone involvement are key predictors of recurrence. High-risk patients require stratified surgical strategies, such as bone debridement, and intensified follow-up.</p>

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Clinicopathological characteristics and prognostic value of Ki-67 in extremity tenosynovial giant cell tumor: a retrospective cohort study highlighting anatomical differences

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月29日

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  • Jinxian Zhao,
  • Jiuxu Yao,
  • Jianhui Lin,
  • Guokai Feng,
  • Jianfeng Chen,
  • Yongqiang Lao,
  • Zongquan Mo

摘要

Background

Tenosynovial giant cell tumor (TGCT) is a common benign soft-tissue neoplasm, typically occurring in joints such as the hand, foot, and knee. However, the heterogeneity in biological behavior across different anatomical locations—particularly between weight-bearing and non-weight-bearing joints—remains to be elucidated. This study aimed to analyze the anatomical distribution characteristics of extremity TGCT, evaluate surgical outcomes and recurrence-associated factors, explore the prognostic significance of key molecular markers (specifically Ki-67), and assess postoperative quality of life using patient-reported outcome measures (PROMs).

Methods

This single-center retrospective study included 82 patients with TGCT of the extremities treated between July 2017 and January 2025. Cases were classified into localized (L-TGCT) and diffuse (D-TGCT) types based on growth patterns and histological findings. Ki-67 expression was analyzed across the entire cohort. The Ki-67 labeling index was dichotomized into low-expression (< 10%) and high-expression (≥ 10%) groups based on a 10% cutoff value derived from previously established prognostic criteria in relevant literature. Recurrence-free survival (RFS) was estimated using the Kaplan-Meier method, and risk factors were identified via multivariable Cox proportional hazards regression. The proportional hazards assumption was verified. PROMs included MSTS-93, NRS, BPI, and PROMIS scales.

Results

The mean age was 39.9 ± 12.8 years. Distribution included 30 hand (36.6%), 27 foot (32.9%), and 25 knee (30.5%) cases. The mean follow-up was 4.8 years. The overall recurrence rate was 30.5% (25/82), with 4 recurrences in the hand, 10 in the foot, and 11 in the knee. Multivariable Cox analysis showed that invasive bone involvement (HR=4.21, p=0.007) and Ki-67 ≥10% (HR=3.52, p=0.021) were independent risk factors for recurrence. All PROMs significantly improved at 6 months postoperatively.

Conclusion

TGCT exhibits significant biological heterogeneity. A Ki-67 index ≥10% and invasive bone involvement are key predictors of recurrence. High-risk patients require stratified surgical strategies, such as bone debridement, and intensified follow-up.