Wedin Rikard, Falkenius Johan, Weiss Rüdiger J, Hansson Johan
Dept of Orthopaedics, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
Acta Orthop Belg. 2012 Apr;78(2):246-53.
The authors retrospectively studied 31 patients with malignant melanoma who were surgically treated for 34 skeletal metastases between 1987 and 2007. The aim was to evaluate the role of orthopaedic surgery and to identify factors related to survival. The patients were operated on for spinal cord compression (n = 12) and metastatic destruction in a long bone (n = 17), or other locations (n = 5). The median survival after surgery was 1.9 months (range: 0-40). The survival rate was 039 at 3 months, and 0.13 at 1 year. Four of 34 operations led to failure necessitating reoperation. A prolonged delay between diagnosis and surgery, radical excision, a solitary skeletal metastasis, radiotherapy, a perioperative lactate dehydrogenase (LDH) level < or = 8 microkat/L (p = 0.04) and a preoperative haemoglobin level > 11.5 mg/dL (p = 0.003) had a favourable prognostic impact. A vertebral localization was unfavourable. These prognostic factors may help identify which melanoma patients with symptomatic skeletal metastases will benefit from orthopaedic surgery. This study represents the largest reported cohort surgically treated for skeletal metastasis of malignant melanoma at a single institution.
作者回顾性研究了1987年至2007年间因34处骨骼转移而接受手术治疗的31例恶性黑色素瘤患者。目的是评估骨科手术的作用并确定与生存相关的因素。患者因脊髓压迫（n = 12）、长骨转移性破坏（n = 17）或其他部位（n = 5）接受手术。术后中位生存期为1.9个月（范围：0 - 40个月）。3个月时生存率为0.39，1年时为0.13。34例手术中有4例导致失败需要再次手术。诊断与手术之间的长时间延迟、根治性切除、孤立性骨骼转移、放疗、围手术期乳酸脱氢酶（LDH）水平≤8微卡特/升（p = 0.04）以及术前血红蛋白水平>11.5毫克/分升（p = 0.003）具有良好的预后影响。椎体定位预后不佳。这些预后因素可能有助于确定哪些有症状性骨骼转移的黑色素瘤患者将从骨科手术中获益。本研究是单一机构报道的接受手术治疗恶性黑色素瘤骨骼转移的最大队列研究。
