Predictors of Recurrence in Hand Giant Cell Tumor of Tendon Sheath: A Systematic Review

Giant cell tumor of the tendon sheath is the second most common soft tissue tumor of the hand. However, reported recurrence rates vary widely (3%-45%), complicating the balance between radical excision and functional preservation. We performed a systematic review to (1) determine the pooled postoperative recurrence rate and (2) identify risk factors associated with recurrence.

We conducted a preferred reporting items for systematic reviews and meta-analyses (PRISMA)-guided review of MEDLINE, Embase, and Cochrane CENTRAL in April 2024. We synthesized data from 12 cohort studies (10 retrospective, 2 prospective; n = 876) to calculate the pooled recurrence rate and analyzed 38 case reports to explore predictors of recurrence using logistic regression. Methodological quality was assessed using the Newcastle-Ottawa Scale.

Pooled recurrence across 11 studies was 13% (95% confidence interval 11%-15%; 107/838 patients). Mean follow-up was 4.2 years, with recurrence typically identified approximately 40 months postoperatively. Fifth-digit involvement was strongly associated with recurrence (odds ratio 18.3; 95% confidence interval 1.0-178.2; P = 0.003), whereas symptom duration and imaging were not independent predictors. Overall study quality was moderate (mean Newcastle-Ottawa score 6.6).

Recurrence is frequent (~13%), and significantly more likely in the little finger, plausibly due to anatomical constraints that hinder complete excision. Surgeons should ensure meticulous margin clearance when treating fifth-digit lesions, followed by prolonged surveillance.