Surgery helps multiple myeloma patients walk again, but survival odds vary widely
A Swedish study of 200 myeloma patients found spinal surgery restored mobility in most cases, but identified four key factors that predict who will live longer. The findings could help oncologists and surgeons better counsel patients on realistic outcomes and guide treatment decisions.
Originaltitel: Predictors of survival and functional outcomes after spinal surgery for multiple myeloma: a nationwide study of 200 patients.
Spinalkirurgi för multipelt myelom bör välja målgrupp utifrån överlevnadsprediktorer. En svenskbaserad kohortstudie av 200 patienter identifierade fyra oberoende faktorer som försämrar överlevnad efter ingreppet: ISS-stadium III, högre ålder, preoperativ immobilitet och metakron sjukdom (över 90 dagar efter diagnos). Medianöverlevnad efter operation var 58 månader. Bland 94 patienter med uppföljningsdata återvann 64 procent av tidigare immobila patienter gångförmågan, medan 96 procent av ambulanta behöll denna. Av 113 med smärtdata rapporterade 72 procent smärtlindring sex veckor postoperativt. För inköpschefer och chefsläkare innebär resultaten ett underlag för triage före elektiv spinalkirurgi. Patienter med metakron presentering och högt ISS-stadium bör bedömas restriktivt, medan tidig intervention hos ambulanta patienter ger bättre funktionell prognos och motiverar palliativ kirurgisk insats i multidisciplinär myelombehandling.
OBJECTIVE: To identify predictors of survival after spinal surgery for multiple myeloma (MM) and evaluate postoperative ambulation and pain at six weeks. METHODS: This retrospective nationwide cohort study included 200 patients from the Swedish Spine Registry and the Swedish Myeloma Registry (2011-2023). Survival was estimated using Kaplan-Meier methods. Multivariable Cox regression models assessed predictors including International Staging System (ISS) stage, hemoglobin, age, preoperative ambulation, and synchronous (≤ 90 days from MM diagnosis) versus metachronous (> 90 days) spinal involvement. RESULTS: Median overall survival from MM diagnosis was 72 months (95% CI, 49.4-94.6), and median postoperative survival was 58 months (95% CI, 38.3-77.7). Multivariable analysis identified ISS stage III (HR, 3.2; 95% CI, 1.2-8.0), older age (HR, 1.03; 95% CI, 1.01-1.06), preoperative non-ambulation (HR, 2.4; 95% CI, 1.3-4.2), and metachronous disease (HR, 3.3; 95% CI, 1.7-6.3) as independent predictors of poorer survival. Paired preoperative and 6-week postoperative data were available for 94 of 200 patients (47%) for ambulation and 113 of 200 patients (56.5%) for pain. Among patients with paired data, 64% of initially non-ambulatory patients regained ambulation, 96% of initially ambulatory patients maintained ambulation, and 72% (81/113) reported improved pain. CONCLUSION: Advanced ISS stage, older age, preoperative non-ambulation, and metachronous disease were independent predictors of reduced survival after spinal surgery for MM. In selected patients with available follow-up data, surgery restored or preserved mobility and provided pain relief, supporting its role in the multidisciplinary management of spinal manifestations of MM.