title: Overall Survival in Spine Myeloma Metastases: Difficulties in Predicting With Prognostic Scores.
abstract: METHODS
  Fifty-one patients with spinal multiple myeloma (MM) metastases were operated and followed between January 2004 and July 2014.
  
  
  OBJECTIVE
  The aim of this study was to consider the efficiency of surgical prognosis scores in the management of spinal metastases myelomas.
  
  
  BACKGROUND
  The spine is the most common site of bone metastases in MM. Surgery in spine metastases MM is a matter of debate and its impact on the increase of a patient's survival time is not clear. Several surgical survival scores have been developed to determine the best treatment in these patients.
  
  
  METHODS
  We studied 51 patients operated for spinal MM metastases between January 2004 and July 2014. We determined the Tokuhashi and Tomita survival scores and compared them with documented patient survivals. The two scores were also compared with the International Staging System (ISS).
  
  
  RESULTS
  Median survival (MS) was 108 months [standard deviation (SD) 62] for ISS I, 132.2 (SD 40) for ISS II, and 45.5 months (SD 16.3) for ISS III (P = 0.09). According to Tokuhashi survival score, 21 patients (41.2%) will survive <6 months, 6 (11.8%) 6 to 12 months, and 24 (47%) >12 months. According to Tomita et al., 50 patients (98%) will survive >49.9 months and 1 patient (2%) <15 months. Regardless of the ISS grade prognosis, Tokuhashi survival score, and to a lesser extent Tomita score, underestimated the actual survival very significantly [P < 0.0001, Log Rank (Mantel-Cox)].
  
  
  CONCLUSIONS
  We suggest that spine surgical prognosis scores are not accurate and are not able to predict the survival of patients with spine myeloma metastases. Spine surgeons have to be guided not by the initial ISS stage but rather by spinal instability and neurological status.
  
  
  METHODS
  N/A.
authors.affiliation: Department of Neurotrauma/Neurosurgery, Nantes University Hospital, Nantes, France.
authors.forename: Aymeric
authors.initials: A
authors.lastname: Amelot
authors.affiliation: Department of Neurotrauma/Neurosurgery, Nantes University Hospital, Nantes, France.
authors.forename: Joseph
authors.initials: J
authors.lastname: Cristini
authors.affiliation: Department of Neurotrauma/Neurosurgery, Nantes University Hospital, Nantes, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Salaud
authors.affiliation: Department of Neurotrauma/Neurosurgery, Nantes University Hospital, Nantes, France.
authors.forename: Alexis
authors.initials: A
authors.lastname: Moles
authors.affiliation: Department of Neurotrauma/Neurosurgery, Nantes University Hospital, Nantes, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Hamel
authors.affiliation: Department of Haematology, Nantes University Hospital, Nantes, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Moreau
authors.affiliation: Department of Neurotrauma/Neurosurgery, Nantes University Hospital, Nantes, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Bord
authors.affiliation: Department of Neurotrauma/Neurosurgery, Nantes University Hospital, Nantes, France.
authors.forename: Kevin
authors.initials: K
authors.lastname: Buffenoir
mesh_terms: D000328:Adult; D000368:Aged; D001855:Bone Marrow Diseases; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality* / Q000556:secondary*; D011379:Prognosis; D012720:Severity of Illness Index; D013125:Spinal Neoplasms / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D013131:Spine / Q000601:surgery*