The Association Between Perioperative Denosumab and Local Recurrence After Surgical Management of Giant Cell Tumors

BACKGROUND: Several studies have assessed the impact of perioperative denosumab on local recurrence (LR) after surgical management of giant cell tumor (GCT), with conflicting results. This meta-analysis evaluates the association between LR in patients undergoing surgical management of GCT and perioperative denosumab, accounting for the type of surgery, number of denosumab doses, and timing of denosumab administration. METHODS: Following the PRISMA guidelines, PubMed, Cochrane, and Google Scholar were searched until December 5, 2024. The extracted outcomes consisted of LR and denosumab-related complications. RESULTS: Sixteen studies from 15 cohorts were included in the meta-analysis. The number of patients totaled 1,551: 310 (20%) in the denosumab group (mean age, 32 years; mean follow-up, 40 months) and 1,241 (80%) in the control group (mean age, 32 years; mean follow-up, 62 months). Patients in the denosumab group had a significantly higher rate of LR compared with patients in the control group (odds ratio = 1.82; p = 0.03), and this remained true even when looking at studies using curettage as the only surgical management (odds ratio = 2.75; p < 0.001). In a subgroup analysis by the timing of denosumab administration, a significantly higher rate of LR was only found among patients receiving denosumab both preoperatively and postoperatively (odds ratio for recurrence relative to control = 5.57; p < 0.001). Overall, the reported incidence of denosumab-related complications was 6.5%. CONCLUSIONS: In this meta-analysis, patients receiving denosumab only preoperatively did not have a significantly increased rate of LR compared with controls. Increased recurrence was observed primarily in patients being treated with both preoperative and postoperative denosumab. LEVEL OF EVIDENCE: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.