脊柱骨髓瘤的手术治疗及预后分析

Outcome and prognosis of spinal myeloma surgery

目的评价脊柱骨髓瘤手术治疗对改善疼痛、神经功能、患者生活质量及生存时间的意义，并分析预后影响因素。方法回顾性分析20例接受手术治疗脊柱骨髓瘤患者的临床资料。男12例，女8例，平均53.3岁。病灶位于颈椎1例，胸椎12例，腰椎6例，骶椎1例。主要症状为疼痛20例，不全截瘫5例。手术方式为单纯后侧入路15例，单纯前侧入路3例，前后联合入路2例。手术前后分别对患者进行疼痛视觉模拟量表评分（VAS）、脊髓损伤Frankel分级、美国东部肿瘤协作组（ECOG）评分，并对患者进行随访和生存分析。结果平均手术时间225 min，平均出血量2 320 ml。术后患者的中位VAS评分、中位ECOG评分分别为2.00和1分，比术前（分别为7.50和3分）明显降低（均P〈0.001），中位Frankel分级为5级，比术前（4级）明显升高（P〈0.001）。术后出现并发症2例，局部复发1例，死亡9例。全组患者5年和10年生存率分别为61.7%和42.3%。化疗与非化疗组患者的3年生存率分别为87.1%和25.0%，5年生存率分别为79.1%和0，差异有统计学意义（P〈0.01）。Cox多因素回归分析显示，乳酸脱氢酶、白蛋白水平及是否化疗是患者预后的独立影响因素，OR分别为1.037（P＝0.006）、0.746（P＝0.009）和0.077（P＝0.012）。结论脊柱骨髓瘤手术治疗能改善患者的生活质量，联合化疗有助于延长生存时间。乳酸脱氢酶、白蛋白水平和是否化疗是脊柱骨髓瘤预后的独立影响因素。

ObjectiveTo evaluate the impact of surgery in pain relief, quality of life, neurological function, survival status and prognosis of spinal myeloma patients.MethodsTwenty spinal myeloma patients from January 1990 to June 2016 who underwent surgery were reviewed. Compare the preoperative and postoperative neurological function and quality of life, via visual analogue scale （VAS）, Eastern Cooperative Oncology Group （ECOG） score and Frankel classification, survival rate based follow-up were statistical analyzed by Wilcoxon and Kaplan-Meier respectively, univariate and multivariate analysis with Cox regression model.ResultsThere were 12 males and 8 females enrolled with average age of 53.3 （range from 31 to 75 years）. Lesions location distribution： cervical spine 1 case, 12 in thoracic spine, 6 in lumbar and 1 in sacral tumor. The majority of symptom was pain in 20 cases and 5 cases had incomplete paraplegia with spinal cord compression. Single posterior approach in 15 cases, single anterior in 3 cases, anterior and posterior combined approach in 2 cases. The average operation time was 225 min, average blood loss was 2 320 ml. The patients with postoperative median VAS score and ECOG score were 2.00 and 1 respectively, it is significantly decreased （P〈0.001） compared with the preoperative score （7.50 and 3）, the median Frankel classification was level 5 in postoperative patients and increased significantly （P〈0.001） than preoperative patients （level 4）. One patient had local recurrence, 2 patients had complications. The overall 5 and 10 year survival rate was 61.7% and 42.3%, respectively. The 3 years survival rate between surgery combine chemotherapy and without chemotherapy group was 87.1% and 25.0%, 5 years survival rate was 79.1% and 0 respectively （P〈0.01）. LDH, ALB and chemotherapy were independent prognostic factors of survival from Cox regression. The odds ratio （OR） was 1.037 （P=0.006）, 0.746 （P=0.009） and 0.077 （P=0.012） respectively.ConclusionSurgical strategy is effective to improve quality of life for spinal myeloma patients. Combine chemotherapy could improve the survival.