Spinal lesions in multiple myeloma: Primary bone tumors with distinct prognostic factors |
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| Institution: | 1. Department of Neurosurgery, CHRU de Tours, Tours, France;2. Department of Neurosurgery, Clairval Private Hospital, Ramsay Generale de Sante, Marseille, France;3. University of Oxford, John Radcliffe Hospital, Headington, Oxford, Oxfordshire, OX3 9DU, UK;4. Department of Hematology, CHRU de Tours, Tours, France;1. Department of Surgery, Boston Medical Center, Boston, MA, USA;2. Boston University School of Medicine, Boston, MA, USA;3. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA;1. University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany;2. University Hospital Cologne, Department of Orthopaedics, Cologne, Germany;3. Emergency Department, University Hospital of Nancy, Nancy, France;4. Center for Resuscitation Medicine, University of Minnesota, Minneapolis, USA;1. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada;2. IRCCS Ospedale Policlinico San Martino, Genova, Italy;3. Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy;4. Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany;5. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany;6. Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy;7. Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy;8. Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, Naples, Italy;9. Department of Urology, Medical University of Graz, Graz, Austria;10. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria;11. Department of Urology, Weill Cornell Medical College, New York, NY, USA;12. Department of Urology, University of Texas Southwestern, Dallas, TX, USA;13. Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan;1. Department of Urology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel;2. Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel;3. The Nutrition and Dietary Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel;4. Department of Urology, Chaim Sheba Medical Center, Ramat-Gan, Israel;5. Department of Urology, Rambam Health Center, Haifa, Israel;6. Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel;7. Department of Urology, Shamir Medical Center, Be''er Ya''akov, Israel;8. Department of Urology, Carmel Medical Center, Haifa, Israel;9. Department of Urology, Rabin Medical Center, Petach-Tikva, Israel;10. Israeli Urologic Oncology Collaboration (IUOC), Israel |
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| Abstract: | PurposeAlthough prognostic factors of spinal multiple myeloma (MM) seem to differ from those of other spine metastases (SpM), the data in the literature remains scarce.MethodsA prospective population of 361 patients treated for spine MM lesions between January 2014 and 2017.ResultsOS for our series was 59.6 months (SD 6.0 months; CI 95%: 47.7–71.3). Cox multivariate proportional-hazards analysis showed that bone marrow transplant HR: 0.390, 95% CI 0.264–0.577; p < 0.0001] and light-chain isotype HR: 0.748, 95% CI 0.318–1.759; p = 0.005] were independent predictors of longer survival. In contrast, age >80 years HR: 2.7, 95% CI 1.6–4.3; p < 0.0001], ISS III HR: 2.510, 95% CI 2.01–3.124; p = 0.001], IgA isotype HR: 1.475, 95% CI 1.031–2.11; p = 0.034] and IgD/M isotype HR: 2.753, 95% CI 1.230–6.130; p = 0.013] were independent poor prognostic factors. However, ECOG (p = 0.486), spine surgery (p = 0.391), spine radiotherapy (p = 0.260), epidural involvement (p = 0.259), the number of vertebra lesions (p = 0.222), and synchronous/metachronous timeline (p = 0.412) were not significantly associated with improved OS.ConclusionsSpinal involvement in the context of MM does not influence OS. The main prognostic factors to consider before spinal surgery are the characteristics of the primary MM disease (ISS score, IgG isotype and systemic treatment). |
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| Keywords: | Myeloma multiple Spine lesions ECOG Survival Surgery |
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