This paper reviews the research situation and development trend of PVNS included in WOS. The number of publications gradually increases each year. Major researchers, institutions, countries and their partnerships have been identified and important publications highly cited have been highlighted. Using the co-occurrence cluster analysis, the co-occurrence relationship network graph was constructed by analyzing the keywords found in related studies. Clin Orthop Relat Res and Skeletal Radiol contain the most publications on PVNS. Harvard University, University Of California System and Mayo Clinic, represent the top three institutions by publication number, with the most publications coming from the United States, China and Germany.
Through the analysis of word co-occurrence, four key points of PVNS were found: arthroscopic synovectomy, joint replacement, radiotherapy and targeted therapy.
PVNS lesion synovial tissue is invasive and can destroy bone, so early surgical resection of diseased synovial tissue is of great significance. At present, synovectomy mainly includes open surgery and arthroscopic surgery. Regardless of the surgical method, there is a possibility of recurrence. The longer the follow-up, the greater the likelihood of recurrence.Different types of lesions have different recurrence rates. For localized pigmented villonodular synovitis (LPVNS), there was no significant difference in recurrence rates in open surgery or arthroscopic surgery, but arthroscopic surgery has fewer complications, so arthroscopic surgery is more recommended for the treatment of LPVNS.For diffuse pigmented villonodular synovitis (DPVNS), Gu. et al. report that multidirectional arthroscopic surgery is superior to open surgery in terms of knee function recovery, and can shorten the length of hospital stay and reduce the amount of bleeding.So arthroscopic surgery is preferred for arthroscopic synovectomy
With the development of surgical techniques and material science, artificial joint replacement has been widely used in the treatment of various end-stage osteoarthropathy. Studies have shown that complete synovectomy combined with joint replacement to treat PVNS can expose the joint more fully and remove the lesion synovium more thoroughly. So the postoperative recurrence rate was lower than synovectomy alone.Houdek et al. studied PVNS patients undergoing 48 total knee replacements (TKA), with a mean follow-up of 14 years, found a 10-year relapse-free survival of 88%.
Casp et al. showed that PVNS patients in TKA had a higher rate of infection and stiffness when compared with the control group. Therefore, the long-term effects of joint replacement for PVNS require more data assessment. Joint replacements still require caution, which is usually reserved for older end-stage patients. Because the patient population of PVNS is about 40 years old, joint replacement is not the best choice unless the joints are very poor or the end-stage bone destruction is severe.
Due to the invasive nature of PVNS, it is difficult to completely remove the lesion synovium when the lesion expands outside the joint or erodes the vascular nerve tract. This is an important cause of postoperative recurrence, and postoperative radiotherapy plays an auxiliary role in eradicating residual small lesions after surgery.And surgery will aggravate irreversible damage to the bone and joints. Radioactive therapy is the most commonly used adjuvant modality, including External beam radiation therapy (EBRT) and Internal radiation synovectomy (RSO).
When analyzed according to different radiotherapy modalities, EBRT, OR = 0.16[95%CI (0.07,0.38)], P < 0.0001, indicating that the recurrence rate of combined EBRT after synovectomy is significantly lower than that of the surgical group alone. For internal radiation synovectomy, OR = 0.54[95%CI (0.25,1.14)], P = 0.10, no significant difference was seen. The results showed that it was feasible to reduce the recurrence rate in combination with EBRT, while no significant evidence was found with RSO.
Radiation therapy can remove residual lesions after surgery, but it is also damage to the tissues around the knee joint, so radiation therapy may be accompanied by complications.Among them, there are some recent conditions, such as joint swelling and transient bone marrow suppression, and there are also long-term, such as skin pigmentation, ischemic necrosis and cancerous degeneration of bone.
Small molecule and monoclonal antibody targeted therapies are being investigated as novel treatment methods for PVNS.Based on the role of CSF-1 in the pathogenesis of PVNS, it is clear that CSF-1R inhibitors (tyrosine kinase inhibitors) can be used clinically as targeted therapeutic agents targeting the CSF-1/CSF-1R axis. The main targeted therapeutic agents are nilotinib, imatinib, ematuzumab, and pecidatinib.
Cassier et al use emmatuzumab to treat advanced DPVNS patients and follow-up for 12 months, which found a total efficiency of 86%.Gelderblom et al treated nilotinib in 56 patients with advanced PVNS who could not be surgically and was controlled in 92.6% of patients.A multicentre retrospective study of Verspoor et al was performed with imatinib in 62 patients with advanced or relapsed DPVNS patients. The result was found to be 31% overall efficient, and the 1 year after surgery and 5 years without progress Survival rates were 71% and 48% respectively.Percidatinib is a more selective and more selective novel oral CSF-1R inhibitor. Giustini et al treated one patient with percidatinib, reducing its tumour volume by 48% and significantly improving both symptoms and function after 4 months.Recently, a phase III clinical trial was treated with percidatinib in 61 patients with advanced PVNS. After 25 weeks, the total effective rate was 39% in the drug treatment group, while none in the placebo group was effective.The results above all show that biologically targeted therapy has achieved some results and has good application prospects.
Changing trends of pigmentation villonodular synovitis and its research
Based on the latest findings, percidatinib has been approved by the US Food and Drug Administration for the treatment of PVNS patients with severe dysfunction and contraindications to surgery. Percidatinib and imatinib are also listed as class 1 and 2A recommended drugs by the latest guidelines of the US National Comprehensive Cancer Network for the systemic treatment of PVNS patients.Patients with PVNS urgently need a drug that can replace surgery, reduce pain, and reduce relapse.The results of existing studies suggest that CSF-1R inhibitors have anti-tumumor activity and acceptable toxicity in patients with inoperable advanced PVNS. However, more research is still needed to address the following issues: Adaptation, treatment dose, course of usage; the combination of treatment methods.
In cases where responses to conventional treatments are poor, bio-targeted treatments show encouraging prospects. However, there is still a long way to go to large-scale applications. Further basic research and clinical trials are needed to accumulate more experience.