The Burden of Surgery for Tenosynovial Giant Cell Tumor: A Targeted Review

OBJECTIVES: Tenosynovial giant cell tumor (TGCT) is a locally aggressive neoplasm arising from the synovium of joints, bursae, and tendon sheaths. TGCT is usually treated by surgical resection. A targeted literature review was conducted to characterize TGCT disease burden; here, we present results on TGCT-related surgical burden.

METHODS: Embase, MEDLINE, and select conferences were searched in August 2023. Eligible studies were in English, published between 2013 and 2023, included ≥20 patients with TGCT (≥40 for humanistic burden studies), and reported epidemiology, humanistic burden, treatment patterns, or economic outcomes. For economic outcomes and treatment patterns, studies that collected data from 2008 and later were included. For studies with multiple publications, those with non-identical populations were considered unique and included.

RESULTS: Of 1,171 records screened, 48 publications reporting on 36 studies were included. Ten studies reported receipt of prior surgery, of which nine reported >50% of patients had prior surgery. In three systemic therapy studies, >25% of patients had ≥2 prior surgeries. Post-operative recurrence rates were up to 67% and were higher for diffuse-type versus localized-type TGCT.

Surgery-related resource use included repeat hospitalizations, imaging, specialist visits, and supplemental care. Joint replacements and amputations were performed more frequently for subsequent versus initial surgeries across all three reporting studies and were associated with longer recovery than arthroscopy in the one reporting study. Surgery-related hospitalizations comprised >70% of total healthcare costs in a European study.

Among 19 studies reporting humanistic burden outcomes, patients frequently reported pain and stiffness, and TGCT negatively impacted health state utilities, quality of life, and physical function. These outcomes generally improved after surgery but were worse among patients with post-operative recurrence.

CONCLUSIONS: TGCT has a high economic and humanistic burden, particularly for diffuse-type TGCT patients, who experience high post-operative recurrence rates. Thus, there is an unmet need for effective treatment options with favorable risk/benefit profiles.