Zeifang F, Zahlten-Hinguranage A, Goldschmidt H, Cremer F, Bernd L, Sabo D
Department of Orthopedic Surgery, University of Heidelberg, Schlierbacher Landstrasse 200, D-69181 Heidelberg, Germany.
Ann Oncol. 2005 Feb;16(2):222-7. doi: 10.1093/annonc/mdi054.
We describe the surgical treatment, outcome and long-term survival of patients with multiple myeloma (MM) in response to conventional (CC) or high-dose (HDT) chemotherapy.
Eighty-four patients diagnosed with MM were recruited for the study (51 male, 33 female; median age 62 years) and consecutively surgically treated in a single institution during a 12-year period. The main end point of the study was overall survival after surgery. Cox regression analysis was used to estimate the effect of factors that may predict survival.
Spinal surgery was performed in 54 cases, and 30 patients were surgically treated at the extremities. The post-surgical complication rate was low (17%; 14/84 patients). The median overall survival time was 47 months. Patients receiving HDT had a longer 5-year overall survival rate than patients receiving CC (51% versus 33%). Univariate predictors of mortality included age >65 years [risk ratio (RR) 1.62; P=0.023], osteolyses in long weight-bearing bones (RR 2.23; P=0.007) and an elevated C-reactive protein level >5 mg/l (RR 1.82; P=0.016); the latter remained significant as a predictor in multivariate analysis (RR 2.66; P=0.0209).
Given the high number of patients reaching 5-year overall survival and the low post-surgery complication rate, surgery should pursue a long-term stable reconstruction of the affected bone.
我们描述了多发性骨髓瘤（MM）患者在接受传统化疗（CC）或大剂量化疗（HDT）后的手术治疗、结果及长期生存率。
84例确诊为MM的患者被纳入本研究（男性51例，女性33例；中位年龄62岁），并在12年期间于单一机构接受连续手术治疗。本研究的主要终点为术后总生存率。采用Cox回归分析来评估可能预测生存的因素的影响。
54例行脊柱手术，30例在四肢接受手术治疗。术后并发症发生率较低（17%；84例患者中有14例）。中位总生存时间为47个月。接受HDT的患者5年总生存率高于接受CC的患者（51%对33%）。死亡率的单因素预测指标包括年龄>65岁[风险比（RR）1.62；P = 0.023]、长负重骨骨溶解（RR 2.23；P = 0.007）以及C反应蛋白水平升高>5 mg/l（RR 1.82；P = 0.016）；在多因素分析中，后者作为预测指标仍具有显著性（RR 2.66；P = 0.0209）。
鉴于达到5年总生存的患者数量较多且术后并发症发生率较低，手术应致力于对患骨进行长期稳定的重建。
