Clinical features and prognosis of treatment of squamous cell carcinoma secondary to chronic osteomyelitis of the tibia
10.3760/cma.j.cn115530-20250527-00229
- VernacularTitle:胫骨慢性骨髓炎继发鳞状细胞癌的临床特征及治疗预后分析
- Author:
Shiqiang WEI
1
;
Hongfa ZHONG
;
Bin CHEN
Author Information
1. 南方医科大学南方医院骨科-创伤骨科，广州 510515
- Publication Type:Journal Article
- Keywords:
Chronic osteomyelitis;
Tibia;
Squamous cell carcinoma;
Prognosis;
Marjolin
- From:
Chinese Journal of Orthopaedic Trauma
2025;27(10):873-880
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the clinical features, strategies, and prognostic factors of treatment of squamous cell carcinoma (SCC) secondary to chronic osteomyelitis of the tibia (COMT).Methods:A computer search was conducted in the PubMed, Embase, Cochrane, Wanfang, VIP, and CNKI databases for cases of SCC arising from COMT published between January 1990 and December 2024. The data extracted were clinical features, treatment strategies, incidence of local recurrence, metastasis, all-cause mortality, and SCC-related mortality. Potential factors influencing the efficacy and prognosis of SCC treatment were investigated.Results:A total of 38 studies involving 101 relevant cases were included (86 males, 15 females). The age at diagnosis of COMT was (29.5±16.5) years while that of SCC (58.8±15.0) years. The disease duration from COMT to SCC was (29.4±15.3) years. The most common etiology was secondary trauma (78.2%, 68/87), and the most frequent symptom local sinus tract formation (61.8%, 55/89). The positive rate of pathogenic culture was 94.4% (34/36), with polymicrobial culture positivity accounting for 73.5% (25/34). The primary treatment was amputation (79.6%, 78/98), followed by wide tumor resection (17.3%, 17/98), while conservative treatment was less frequently applied (3.1%, 3/98). The overall local recurrence rate was 19.6% (11/56), the metastasis rate 14.5% (8/55), the all-cause mortality 25.0% (23/92), and the SCC-related mortality 9.8% (9/92). The patients with regional lymph node involvement at the time of diagnosis of SCC secondary to COMT had significantly higher risks of local recurrence, SCC-related mortality, and all-cause mortality than those without lymph node involvement ( P<0.05). Similarly, patients with moderately to poorly differentiated SCC had significantly higher risks of local recurrence, metastasis, and all-cause mortality than those with well-differentiated SCC ( P<0.05). Conclusions:SCC secondary to COMT occurs predominantly in males, has a long disease course, and presents primarily with sinus tracts and ulcers as clinical symptoms. Amputation is the main treatment strategy, but the overall prognosis remains poor, with high incidences of local recurrence, metastasis, and cancer-related mortality. Those with local lymph node involvement and moderately to poorly differentiated SCC have a worse prognosis which requires close follow-up.
