多发性骨髓瘤患者脊柱疾病手术治疗与非手术治疗结果的比较研究：北爱尔兰的经验

A Comparative Study of the Outcomes of Surgically Versus Non-Surgically Treated Spinal Disease in Patients With Multiple Myeloma: Northern Ireland's Experience.

作者信息

McCalmont Amber, Darwish Nagy, Donaldson David, Meguid Eiman Abdel

机构信息

Queen's University Belfast School of Medicine Dentistry and Biomedical Sciences Belfast UK.

Royal Victoria Hospital Trauma and Orthopaedics Belfast UK.

出版信息

EJHaem. 2025 Jun 1;6(3):e70071. doi: 10.1002/jha2.70071. eCollection 2025 Jun.

DOI:10.1002/jha2.70071

PMID:40454384

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12126995/

Abstract

BACKGROUND

Multiple myeloma is a haematological malignancy which is characterised by the proliferation of cancerous plasma cells in the bone marrow. The role of spinal surgery in the management of myeloma is debatable. Therefore, this retrospective study aimed to compare the outcomes of treatment of patients with myeloma whose spinal disease was managed surgically and/or non-surgically.

METHODS

A total of 159 patients were reviewed retrospectively. To compare the outcomes of treatment in both cohorts, three outcome measures were selected, including back-pain reduction, neurological status, and survival duration. In addition, the extent and distribution of vertebral disease was assessed using MRI Whole Spine reports.

RESULTS

There was no significant difference in the percentage of patients in each cohort reporting back-pain pretreatment and at the two follow-up periods ( > 0.05). Regarding neurological status, 23% of the surgical cohort improved, 53% remained stable and 7% deteriorated. In comparison, the non-surgical cohort displayed no significant changes in neurological status post-treatment. The mean duration of survival was significantly longer in the cohort who received surgery (77 vs. 24 months, = 0.014). However, the mean age of diagnosis was significantly lower in this cohort (59 vs. 71 years, < 0.001). T12 was the most commonly diseased vertebral level across both cohorts. At the time of diagnosis, the average number of diseased vertebrae per patient was 3.5 in the surgical cohort and 3.6 in the non-surgical cohort.

CONCLUSION

This comparative study has shown that back pain alone should not be an indication for spinal surgery. However, surgical intervention may successfully prevent neurological deterioration. Although surgical intervention is associated with prolonged survival, this may be confounded by demographic variables, such as age. Importantly, most patients displayed multi-level disease at the time of diagnosis.

TRIAL REGISTRATION

The authors have confirmed clinical trial registration is not needed for this submission.

摘要

背景

多发性骨髓瘤是一种血液系统恶性肿瘤，其特征是骨髓中癌细胞性浆细胞增殖。脊柱手术在骨髓瘤治疗中的作用存在争议。因此，本回顾性研究旨在比较脊柱疾病接受手术和/或非手术治疗的骨髓瘤患者的治疗结果。

方法

对159例患者进行回顾性分析。为比较两组的治疗结果，选择了三项结果指标，包括背痛减轻、神经状态和生存时间。此外，使用MRI全脊柱报告评估椎体疾病的范围和分布。

结果

每组患者在治疗前及两个随访期报告背痛的百分比无显著差异（>0.05）。关于神经状态，手术组23%的患者有所改善，53%保持稳定，7%恶化。相比之下，非手术组治疗后神经状态无显著变化。接受手术的患者组平均生存时间显著更长（77个月对24个月，P = 0.014）。然而，该组的平均诊断年龄显著更低（59岁对71岁，P < 0.001）。T12是两组中最常患病的椎体节段。诊断时，手术组每位患者的平均患病椎体数为3.5个，非手术组为3.6个。