Department of Orthopedic Surgery, Sheba Medical Center, Tel Hashomer, affiliated with the Sackler School of Medicine, Tel Aviv, Israel.
Department of Orthopedic Surgery, Edith Wolfson Medical Center, affiliated with the Sackler School of Medicine, Ha-Lokhamim St 62, 5822012, Tel Aviv Holon, Israel.
BMC Cancer. 2024 Jul 30;24(1):917. doi: 10.1186/s12885-024-12681-0.
The femur is a common site for Multiple Myeloma (MM) involvement. This study explores the impact of preventive surgery for anticipated femoral pathological fractures (IFF), based on Mirels classification, versus treatment of pathological femur fracture (PFF) on MM patient mortality and morbidity.
Retrospective cohort of 33 patients undergoing surgery due to femoral MM involvement (2004-2015), 18 patients with PFF, 15 patients with IFF, followed up until deceased or to July 2016. Demographic data, oncological, pathological, radiation, surgical reports, outpatient clinical records, and imaging studies were studied. Exclusion criteria included patients who had surgery at other medical centers.
The mean age was 70.4 ± 13.6 and 62.6 ± 12.2 years (p = 0.1) in the PFF and the IFF cohorts, respectively, primarily women (55.6% and 46.7%, respectively). The average Mirels' score was 10.4 ± 1.2. Post-operative complications were observed in 25% of patients, with no difference between IFF & PFF. We did not find a difference in mortality between IFF and PFF cohorts (p = 0.59).
The femur is commonly involved in MM. This study found that actual fractures, compared to imminent fractures, do not affect MM morbidity or mortality. Our study shows that proximal femoral MM behaves differently from proximal femoral metastatic disease regarding the impact of surgery on life span. Due to the fracture healing potential of MM, an IFF can probably be treated initially conservatively unless it progresses to an actual fracture needing surgery. Future, more extensive studies are required before revolutionizing the proximal femoral Multiple Myeloma-related involvement treatment paradigm.
股骨是多发性骨髓瘤（MM）常见的受累部位。本研究探讨了基于 Mirels 分类的预防性手术（IFF）与病理性股骨骨折（PFF）治疗对 MM 患者死亡率和发病率的影响。
回顾性分析了 2004 年至 2015 年期间因股骨 MM 受累而接受手术的 33 例患者的队列研究，其中 18 例为 PFF，15 例为 IFF，随访至死亡或 2016 年 7 月。研究了人口统计学、肿瘤学、病理学、放射学、手术报告、门诊临床记录和影像学研究。排除标准包括在其他医疗中心接受手术的患者。
PFF 和 IFF 组的平均年龄分别为 70.4±13.6 岁和 62.6±12.2 岁（p=0.1），主要为女性（分别为 55.6%和 46.7%）。平均 Mirels 评分分别为 10.4±1.2。术后并发症发生率为 25%，IFF 和 PFF 之间无差异。我们没有发现 IFF 和 PFF 队列之间的死亡率有差异（p=0.59）。
股骨是 MM 常见的受累部位。本研究发现，实际骨折与即将发生的骨折相比，不会影响 MM 的发病率或死亡率。我们的研究表明，与股骨转移性疾病相比，股骨近端 MM 在手术对寿命的影响方面表现不同。由于 MM 骨折愈合的潜力，IFF 可能最初可以保守治疗，除非它进展为需要手术的实际骨折。未来，需要进行更多广泛的研究，才能彻底改变股骨近端多发性骨髓瘤相关受累的治疗模式。
