Surgical Treatment and Prognosis of Multiple Myeloma Bone Disease / 中华骨科杂志

ABSTRACT

Objective To evaluate the effect of surgical treatment for pain relief,quality of life,survival status of patients and analyze prognostic factors with multiple myeloma bone disease.Methods Retrospective analyzed 43 consecutive patients from June 1992 to June 2016 who underwent surgery in our department.Twenty five males and 15 females were enrolled with average age of 56.8 (ranged28-81 years).Lesions location distributionupper limb in 13 cases,lower extremity in 26 cases,pelvic 3 cases and trunk 2 cases.One patient had two lesions in humerus and femur.The main symptoms manifested 35 cases of pain (81.4％) and 22 cases (51.2％) of pathological fractures,including 11 cases of upper and lower limbs.Limbs surgical included curettage and fixation in 22 cases,segment resection and prosthesis replacement in 11 cases,allograft replacement in 1 case,internal fixation without removal the tumor in 3 cases and resection without reconstruction in 2 cases.Pelvic surgical included 1 curettage,1 resection with Iliofemoral fusion and 1 resection with acetabular reconstruction of total hip replacement.Trunk surgery included scapulectomy 1 case and rib resection 1 case.The postoperative pain relief,via visual analogue scale (VAS) and Eastern Cooperative Oncology Group (ECOG) score were analyzed by Wilcoxon.MSTS score was analyzed by paired-samples t-test.Survival rate and local recurrence were analyzed by Kaplan-Meier and Chi-square respectively.We collected gender,age,number of lesions,laboratory test (HB,CRP,ALB,Cre,LDH),chemotherapy and surgical marginal for multivariate analysis with Cox regression model.Results The average time and blood loss were 164 mins (40-290 mins) and 883ml (50-7 000 ml) respectively.The Mirels score for limb tumor patients averaged 9.97 and the median score was 10 (8-12).The quality of life ECOG (Z=-5.622,P=0.000),pain relief VAS (Z=-5.671,P=0.000) and MSTS score (t=-18.520,P=0.000) were improved significantly.Four patients occurred local recurrences (4/43,9.3％) and there was no significant difference between curettage and resection cases (x2=3.175,P=0.127).Four patients occurred complications (4/43,9.3％).The overall survival rate at 1 year,3 years,5 years and 10 years was 90.7％,76.8％,63％ and 57.7％ respectively.The 5-year survival rate of pathological fracture cases was lower than others (x2=7.734,P=0.005).The survival rate was significant difference between patients with and without chemotherapy (x2=12.043,P=0.001).The survival rate was significantly influenced by ALB,CRP,LDH,pathological fracture and chemotherapy indicated by univariate analysis.CRP,pathological fracture and chemotherapy were independent prognostic factors as Cox regression showed.Conclusion Our surgical strategy is effective to relieve pain and improve myeloma patients' living with minor complications;Chemotherapy could improve the postoperative survival rate significantly.CRP and pathological fracture were independent prognostic factors.