脊柱骨孤立性浆细胞瘤：监测、流行病学和最终结果（SEER）登记处的结果。
Solitary Plasmacytoma of Bone of the Spine: Results From Surveillance, Epidemiology, and End Results (SEER) Registry.
机构信息
Department of Orthopedic Surgery, Second Affiliated Hospital, Harbin Medical University, Harbin, China.
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
出版信息
Spine (Phila Pa 1976). 2019 Jan 15;44(2):E117-E125. doi: 10.1097/BRS.0000000000002777.
STUDY DESIGN
Retrospective analysis.
OBJECTIVE
To determine the prognostic indicators in patients with solitary plasmacytoma of bone (SPB) of the spine.
SUMMARY OF BACKGROUND DATA
Population-level estimates for prognosis among patients with SPB of the spine are still lacking. Sociodemographic and clinical predictors of outcome have not been well characterized.
METHODS
The Surveillance, Epidemiology, and End Results Registry was used to identify all patients with SPB of the spine from 1995 through 2014. Associated population data were used to determine annual incidence and limited-duration prevalence. Overall survival (OS) estimates were obtained using the Kaplan-Meier method and compared across groups using log-rank test. A Cox regression model was used for multivariate analysis of survival. Logistic regression was performed to identify predictors of the progression to multiple myeloma (MM).
RESULTS
The incidence and prevalence of the disease increased during the study period. Spinal SPB most commonly affected older people (>50) with a male preponderance. The median OS were 74.0 months. The 5 and 10-year survival rates for these patients were 56.1% and 36.7%, respectively. On multivariable analyses, older age, and surgery without radiotherapy were correlated with poor survival of patients with spinal SPB. The 3-year probability of progression to MM was 10.1%. Patients aged >70 years were associated with progression to MM. There was no significant association between the methods of surgical resection (radical or local/partial) and OS or progression to MM.
CONCLUSION
The findings of this study provide population-based estimates of the incidence, prevalence and prognosis for patients with SPB of the spine. This analysis indicated that the only identifiable prognostic indicators were older age and surgery without radiotherapy. Moreover, the methods of surgical resection did not influence the OS or progression to MM.
LEVEL OF EVIDENCE
研究设计
回顾性分析。
目的
确定脊柱孤立性浆细胞瘤（SPB）患者的预后指标。
背景数据摘要
目前仍缺乏脊柱 SPB 患者的人群水平预后估计。社会人口统计学和临床结果预测因素尚未得到很好的描述。
方法
使用监测、流行病学和最终结果登记处（Surveillance, Epidemiology, and End Results Registry）确定了 1995 年至 2014 年间所有脊柱孤立性浆细胞瘤患者。利用相关人群数据确定了每年的发病率和有限持续时间的患病率。使用 Kaplan-Meier 方法获得总生存（Overall survival，OS）估计值，并使用对数秩检验比较组间差异。使用 Cox 回归模型进行生存的多变量分析。使用逻辑回归识别多发性骨髓瘤（Multiple myeloma，MM）进展的预测因素。
结果
在研究期间，该疾病的发病率和患病率均有所增加。脊柱 SPB 最常影响年龄较大的人群（>50 岁），且男性居多。中位 OS 为 74.0 个月。这些患者的 5 年和 10 年生存率分别为 56.1%和 36.7%。多变量分析显示，年龄较大和手术未放疗与脊柱 SPB 患者的不良生存相关。3 年内进展为 MM 的概率为 10.1%。年龄>70 岁的患者与进展为 MM 相关。手术切除的方法（根治性或局部/部分）与 OS 或进展为 MM 之间无显著关联。
结论
本研究结果提供了脊柱孤立性浆细胞瘤患者的发病率、患病率和预后的人群水平估计。该分析表明，唯一可识别的预后指标是年龄较大和手术未放疗。此外，手术切除的方法并不影响 OS 或进展为 MM。
证据水平
4 级。
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