Clinicopathological characteristics and prognostic value of Ki-67 in extremity tenosynovial giant cell tumor: a retrospective cohort study highlighting anatomical differences
- 1The Eighth Clinical Medical College, Guangzhou University of Chinese Medicine, Foshan, China
- 2Department of Orthopaedic Surgery, Foshan Hospital of Traditional Chinese Medicine, Foshan, China
Abstract
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.
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BibTeX
@article{zhao2026clinicopathological,
title = {{Clinicopathological characteristics and prognostic value of Ki-67 in extremity tenosynovial giant cell tumor: a retrospective cohort study highlighting anatomical differences}},
author = {Jinxian Zhao and Jiuxu Yao and Jianhui Lin and Guokai Feng and Jianfeng Chen and Yongqiang Lao and Zongquan Mo},
journal = {Journal of Orthopaedic Surgery and Research},
year = {2026},
month = jul,
doi = {10.1186/s13018-026-07067-w},
url = {https://doi.org/10.1186/s13018-026-07067-w},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Clinicopathological characteristics and prognostic value of Ki-67 in extremity tenosynovial giant cell tumor: a retrospective cohort study highlighting anatomical differences
AU - Jinxian Zhao
AU - Jiuxu Yao
AU - Jianhui Lin
AU - Guokai Feng
AU - Jianfeng Chen
AU - Yongqiang Lao
AU - Zongquan Mo
PY - 2026
DA - 2026/07/29
JO - Journal of Orthopaedic Surgery and Research
DO - 10.1186/s13018-026-07067-w
UR - https://doi.org/10.1186/s13018-026-07067-w
AB - 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.
SN - 1749-799X
ER -