[Outcome and prognosis of spinal myeloma surgery].

Objective

To evaluate the impact of surgery in pain relief, quality of life, neurological function, survival status and prognosis of spinal myeloma patients.

Methods

Twenty spinal myeloma patients from January 1990 to June 2016 who underwent surgery were reviewed. Compare the preoperative and postoperative neurological function and quality of life, via visual analogue scale (VAS), Eastern Cooperative Oncology Group (ECOG) score and Frankel classification, survival rate based follow-up were statistical analyzed by Wilcoxon and Kaplan-Meier respectively, univariate and multivariate analysis with Cox regression model.

Results

There were 12 males and 8 females enrolled with average age of 53.3 (range from 31 to 75 years). Lesions location distribution: cervical spine 1 case, 12 in thoracic spine, 6 in lumbar and 1 in sacral tumor. The majority of symptom was pain in 20 cases and 5 cases had incomplete paraplegia with spinal cord compression. Single posterior approach in 15 cases, single anterior in 3 cases, anterior and posterior combined approach in 2 cases. The average operation time was 225 min, average blood loss was 2 320 ml. The patients with postoperative median VAS score and ECOG score were 2.00 and 1 respectively, it is significantly decreased (P<0.001) compared with the preoperative score (7.50 and 3), the median Frankel classification was level 5 in postoperative patients and increased significantly (P<0.001) than preoperative patients (level 4). One patient had local recurrence, 2 patients had complications. The overall 5 and 10 year survival rate was 61.7% and 42.3%, respectively. The 3 years survival rate between surgery combine chemotherapy and without chemotherapy group was 87.1% and 25.0%, 5 years survival rate was 79.1% and 0 respectively (P<0.01). LDH, ALB and chemotherapy were independent prognostic factors of survival from Cox regression. The odds ratio (OR) was 1.037 (P=0.006), 0.746 (P=0.009) and 0.077 (P=0.012) respectively.

Conclusion

Surgical strategy is effective to improve quality of life for spinal myeloma patients. Combine chemotherapy could improve the survival.