Department of Hematology, Beijing Jishuitan Hospital, Beijing, China.
Department of Epidemiology and Statistics, Beijing Jishuitan Hospital, Beijing, China.
Ann Hematol. 2023 Jun;102(6):1513-1522. doi: 10.1007/s00277-023-05202-9. Epub 2023 Mar 30.
The indications for percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP) are painful vertebral compression fractures. Our study is to assess the risk-benefit ratio of PKP/PVP surgery in the patients with newly diagnosed multiple myeloma (NDMM) without receiving antimyeloma therapy. The clinical data of 426 consecutive patients with NDMM admitted to our center from February 2012 to April 2022 were retrospectively analyzed. The baseline data, postoperative pain relief, the proportion of recurrent vertebral fractures, and survival time were compared between the PKP/PVP surgical group and the nonsurgical group in the NDMM patients. Of the 426 patients with NDMM, 206 patients had vertebral fractures (206/426, 48.4%). Of these, 32 (32/206, 15.5%) underwent PKP/PVP surgery for misdiagnosis of simple osteoporosis prior to diagnosis of MM (surgical group), and the other 174 (174/206, 84.5%) did not undergo surgical treatment prior to definitive diagnosis of MM (non-surgical group). The median age of patients in the surgical and nonsurgical groups was 66 and 62 years, respectively (p = 0.01). The proportion of patients with advanced ISS and RISS stages was higher in the surgical group (ISS stage II + III 96.9% vs. 71.8%, p = 0.03; RISS stage III 96.9% vs. 71%, p = 0.01). Postoperatively, 10 patients (31.3%) never experienced pain relief and 20 patients (62.5%) experienced short-term pain relief with a median duration of relief of 2.6 months (0.2-24.1 months). Postoperative fractures of vertebrae other than the surgical site occurred in 24 patients (75%) in the surgical group, with a median time of 4.4 months postoperatively (0.4-86.8 months). Vertebral fractures other than the fracture site at the first visit occurred in 5 patients (2.9%) in the nonoperative group at the time of diagnosis of MM, with a median time of 11.9 months after the first visit (3.5-12.6 months). The incidence of secondary fractures was significantly higher in the surgical group than in the nonsurgical group (75% vs. 2.9%, p = 0.001). The time interval between the first visit and definitive diagnosis of MM was longer in the surgical group than in the nonsurgical group (6.1 months vs. 1.6 months, p = 0.01). At a median follow-up of 32 months (0.3-123 months), median overall survival (OS) was significantly shorter in the surgical group than in the nonsurgical group (48.2 months vs. 66 months, p = 0.04). Application of PKP/PVP surgery for pain relief in NDMM patients without antimyeloma therapy has a limited effect and a high risk of new vertebral fractures after surgery. Therefore, patients with NDMM may need to have their disease controlled with antimyeloma therapy prior to any consideration for PKP/PVP surgery.
经皮椎体后凸成形术（PKP）和经皮椎体成形术（PVP）的适应证为疼痛性椎体压缩性骨折。我们的研究旨在评估新诊断的多发性骨髓瘤（NDMM）患者在未接受抗骨髓瘤治疗的情况下行 PKP/PVP 手术的风险效益比。回顾性分析了 2012 年 2 月至 2022 年 4 月期间我院收治的 426 例连续 NDMM 患者的临床资料。比较了 PKP/PVP 手术组和非手术组 NDMM 患者的基线数据、术后疼痛缓解、复发性椎体骨折比例和生存时间。426 例 NDMM 患者中，206 例（206/426，48.4%）有椎体骨折。其中，32 例（32/206，15.5%）在 MM 确诊前因单纯骨质疏松症误诊而行 PKP/PVP 手术（手术组），174 例（174/206，84.5%）在 MM 确诊前未行手术治疗（非手术组）。手术组和非手术组患者的中位年龄分别为 66 岁和 62 岁（p=0.01）。手术组中晚期 ISS 和 RISS 分期患者比例较高（ISS 分期 II+III 96.9% vs. 71.8%，p=0.03；RISS 分期 III 96.9% vs. 71%，p=0.01）。术后，10 例（31.3%）患者从未经历过疼痛缓解，20 例（62.5%）患者经历了短期疼痛缓解，缓解中位持续时间为 2.6 个月（0.2-24.1 个月）。术后 24 例（75%）手术组患者出现手术部位以外的椎体骨折，术后中位时间为 4.4 个月（0.4-86.8 个月）。在 MM 确诊时，非手术组中有 5 例（2.9%）患者发生初次就诊时以外部位的椎体骨折，初次就诊后中位时间为 11.9 个月（3.5-12.6 个月）。手术组的继发性骨折发生率明显高于非手术组（75% vs. 2.9%，p=0.001）。手术组首次就诊至 MM 确诊的时间间隔长于非手术组（6.1 个月 vs. 1.6 个月，p=0.01）。中位随访 32 个月（0.3-123 个月）时，手术组的总生存（OS）明显短于非手术组（48.2 个月 vs. 66 个月，p=0.04）。在未接受抗骨髓瘤治疗的 NDMM 患者中，应用 PKP/PVP 手术缓解疼痛的效果有限，且术后新发椎体骨折的风险较高。因此，NDMM 患者在考虑 PKP/PVP 手术之前可能需要接受抗骨髓瘤治疗来控制疾病。
