Age-Related Differences in Surgical Management of Giant Cell Tumor of Bone: A Nationwide Registry Analysis

Background: Giant cell tumor of bone (GCTB) rarely affects elderly individuals, and its clinical characteristics in this population remain insufficiently defined. This study aimed to investigate epidemiologic features and age-related differences in the surgical management of GCTB using a nationwide registry. Methods: Patients with histologically confirmed benign GCTB recorded in the Japanese Bone and Soft Tissue Tumor (BSTT) Registry between 2006 and 2019 were analyzed. Clinical characteristics, treatment patterns, and postoperative outcomes were compared among peak-incidence (20–45 years), middle-aged (46–64 years), and elderly (≥65 years) groups. Results: Among 1,978 eligible cases, 173 patients (8.7%) were aged 65 years or older. Surgical intervention decreased with increasing age and was lowest in the elderly group (88%, 80%, and 75%, respectively; p < 0.001). After 2014, the proportion of elderly patients undergoing surgery declined significantly from 85% to 66% (p = 0.005). When surgery was performed, elderly patients more frequently underwent marginal or wide resection, whereas intralesional curettage predominated in younger adults. Conclusions: This nationwide registry analysis demonstrates age-related differences in the surgical management of GCTB. Although the proportion of patients undergoing surgery decreased after 2014, causal relationships with denosumab approval cannot be established in this registry-based study. Reduced use of surgery did not necessarily imply less extensive surgical management among patients who underwent surgery. These findings support individualized, age-sensitive treatment strategies.