黑色素瘤脊柱转移患者手术预后因素分析:一项回顾性队列研究OA

Background and purpose:Melanoma is a highly malignant tumor with a relatively low incidence rate but a high fatality rate.When melanoma metastasizes to the spine,it exhibits strong aggressiveness,often invading the vertebral body and forming soft tissue masses.As the tumor progresses,it further compresses the nerve roots and spinal cord,causing severe pain in patients,which can lead to paralysis in severe cases.Therefore,surgical intervention is required for patients with spinal metastasis of melanoma as soon as possible.This study aimed to explore surgical treatment and prognostic factors for patients with spinal metastasis from melanoma.Methods:Clinical and follow-up data of 58 patients with melanoma spinal metastases admitted to the Affiliated Tumor Hospital of Xinjiang Medical University from 2008 to 2024 were collected.Inclusion criteria:① Patients with confirmed melanoma who have undergone spinal surgery and have been pathologically diagnosed with metastasis;② Estimated survival time greater than 3 months;③ Have already experienced or are about to experience spinal instability and/or spinal cord compression.Exclusion criteria:① Patients with other malignant tumors;② Patients who cannot tolerate surgery upon evaluation;③ Patients with incomplete follow-up data;④ Patients with brain metastasis.This study was approved by the ethics committee of the Affiliated Tumor Hospital of Xinjiang Medical University(ethics approval number:S-2024167),and exempted from obtaining informed consent from patients.According to the stratification of treatment periods,the differences in treatment strategies at different stages were analyzed,and the treatment period was included as a covariate in the multivariate model.Before and after surgery,patients were evaluated using the visual analogue scale(VAS)for pain,Frankel classification for spinal cord injury,and the Eastern Cooperative Oncology Group(ECOG)score.The Kaplan-Meier method was used for survival analysis,the log-rank test was used for intergroup survival rate comparison,and Cox regression analysis was used to identify the influencing factors of patient prognosis.Results:The median overall survival(OS)for 58 patients with melanoma spinal metastases was 11 months.The average surgical duration was 273 minutes,with an average blood loss of 1 407 mL.Compared to preoperative levels,postoperative patients exhibited significantly reduced VAS and ECOG scores,along with a notable improvement in Frankel grading(all P＜0.05).Univariate analysis revealed that the ECOG score,preoperative Frankel grading,interval from melanoma diagnosis to spinal metastasis,presence of non-spinal metastases,receipt of postoperative systemic therapy,and type of postoperative systemic therapy were all significantly correlated with OS in melanoma patients with spinal metastasis(all P＜0.05).After adjusting for the treatment era,multivariate Cox regression analysis showed that preoperative Frankel grading[hazard ratio(HR)=0.173,95%CI:0.043-0.700],non-spinal metastases(HR=4.131,95%CI:1.863-9.159)and postoperative systemic therapy(HR=0.048,95%CI:0.009-0.250)were independent factors affecting OS in patients with melanoma spinal metastases.Conclusion:Surgical treatment can significantly alleviate the pain of patients with melanoma spinal metastases and improve their quality of life.Preoperative Frankel grading,metastasis outside the spine,and whether postoperative systemic therapy is received are independent factors affecting the OS of melanoma patients with spinal metastases.