Advertisement

Prognostic factors of patients with spinal malignant melanoma after surgical intervention: a case series of 21 patients and literature review

  • Zhichao Zhang
  • Haiyi Gong
  • Chenglong Zhao
  • Dongsheng Wang
  • Ming QianEmail author
  • Zhipeng WuEmail author
  • Jianru XiaoEmail author
Clinical Study

Abstract

Background

Spinal malignant melanoma (SMM) is a rare type of tumor that can cause nerve roots or spinal cord compression. Patients often suffer from fierce pain and paralyzation. And the estimated survival time were less than 6 months. Surgical interventions to remove the tumor and decompress the nearby nerve roots and spinal cord are effective management. Unfortunately, there lack a thorough and persuasive surgical guideline that specifically aims for this disease. It is necessary to obtain some clinical prognostic factors that predict the recurrence rate and overall survival (OS) of patients with SMM who underwent surgical interventions.

Methods

21 patients with SMM who underwent surgical intervention were retrospectively reviewed. Related patients factors, treatment factors and tumor factors were acquired and subjected into survive analyses using Kaplan–Meier method and the log-rank test. Further Cox proportional hazards model was used to identify independent prognostic factors. Literature regarding surgical interventions on SMM patients were reviewed and summarized as well.

Results

Surgical approach total en-bloc spondylectomy (TES/Piecemeal) (p = 0.015, B 0.029, 95%CI 0.002–0.508), preoperative Frankel grade (A–C/D–E) (p = 0.021, B 15.041, 95%CI 1.492–151.669) and tumor metastases (Yes/No) (p = 0.013, B 16.667, 95%CI 1.805–153.897) are independent prognostic factors for recurrence free survival (RFS). Preoperative Frankel grade (A–C/D–E) (p = 0.031, B 10.676, 95%CI 1.241–91.877) is independent prognostic factors for OS. 12 literatures have been reviewed, including 11 case reports and one retrospective study.

Conclusions

Surgical interventions for patients with SMM are beneficial. Surgical approach (TES/piecemeal), tumor origin (primary/metastasis) and preoperative Frankel grade (A–C/D–E) are independent risk factors in predicting RFS. Preoperative Frankel grade (A–C/D–E) is independent prognostic factor in predicting OS.

Keywords

Spinal malignant melanoma Surgery en-bloc resection PD-1/PD-L1 Prognostic factors 

References

  1. 1.
    Domingues B, Lopes JM, Soares P, Pópulo H (2018) Melanoma treatment in review. Immunotarget Ther 7:35–49CrossRefGoogle Scholar
  2. 2.
    Stubblefield J, Kelly B (2014) Melanoma in non-caucasian populations. Surg Clin N Am 94:1115–1126 (ix)CrossRefGoogle Scholar
  3. 3.
    McLaughlin JP, Fung AT, Shields JA, Shields CL (2013) Iris melanoma in children: current approach to management. Oman J Ophthalmol 6:53–55Google Scholar
  4. 4.
    Hastings-James R (1973) Melanoma of the central nervous system. Radiology 109:357–360CrossRefGoogle Scholar
  5. 5.
    Zekri J, Marples M, Taylor D, Kandukurti K, McParland L, Brown JE (2017) Complications of bone metastases from malignant melanoma. J Bone Oncol 8:13–17CrossRefGoogle Scholar
  6. 6.
    Gokaslan ZL, Aladag MA, Ellerhorst JA (2000) Melanoma metastatic to the spine: a review of 133 cases. Melanoma Res 10:78–80CrossRefGoogle Scholar
  7. 7.
    Moser JC, Grossman KF (2018) Adjuvant therapy for resected high-risk melanoma. Semin Cutan Med Surg 37:109–111CrossRefGoogle Scholar
  8. 8.
    Johnson DB, Chon J, Johnson MR, Balko JM (2018) Biomarkers for immune therapy in melanoma. Semin Cutan Med Surg 37:120–126CrossRefGoogle Scholar
  9. 9.
    Zhao C, Zhang Z, Zhong N et al (2018) Outcomes and prognostic factors for surgically treated patients with breast cancer spine metastases. J Bone Oncol 12:38–43CrossRefGoogle Scholar
  10. 10.
    Gao X, Zhao C, He S et al (2018) Treatment and outcomes of 28 patients with spinal metastasis from gynecological cancer. J Neurooncol 137:387–394CrossRefGoogle Scholar
  11. 11.
    Sellin JN, Gressot LV, Suki D et al (2015) Prognostic factors influencing the outcome of 64 consecutive patients undergoing surgery for metastatic melanoma of the spine. Neurosurgery 77:386–393 (discussion 393)CrossRefGoogle Scholar
  12. 12.
    Buchanan RCM, Kirksey K (2016) Poster 275 acute encephalopathy in the setting of paraplegia secondary to metastatic melanoma to the lumbar spine: a case report. PM R 8:S249–S249S250CrossRefGoogle Scholar
  13. 13.
    Hering K, Bresch A, Lobsien D, Mueller W, Kortmann RD, Seidel C (2016) Primary intradural extramedullary spinal melanoma in the lower thoracic spine. Case Rep Oncol Med 2016:3815280Google Scholar
  14. 14.
    Hwang JK, Kim KH, Kim JS, Ahn SJ, Kuh SU (2017) Late-developing metastatic malignant melanoma in the thoracic spine originating from choroidal melanoma. Korean J Spine 14:53–56CrossRefGoogle Scholar
  15. 15.
    Jeong DH, Lee CK, You NK, Kim SH, Cho KH (2013) Primary spinal cord melanoma in thoracic spine with leptomeningeal dissemination and presenting hydrocephalus. Brain Tumor Res Treat 1:116–120CrossRefGoogle Scholar
  16. 16.
    Katalinic D, Anic B, Stern-Padovan R et al (2011) Low back pain as the presenting sign in a patient with primary extradural melanoma of the thoracic spine—a metastatic disease 17 years after complete surgical resection. World J Surg Oncol 9:150MCrossRefGoogle Scholar
  17. 17.
    Mandaliya H, Singh N, George S, George M (2016) Choroid melanoma metastasis to spine: a rare case report. Case Rep Ophthalmol Med 2016:2732105Google Scholar
  18. 18.
    Marx S, Fleck SK, Manwaring J, Vogelgesang S, Langner S, Schroeder HW (2014) Primary leptomeningeal melanoma of the cervical spine mimicking a meningioma—a case report. J Neurol Surg Rep 75:e93–e97CrossRefGoogle Scholar
  19. 19.
    Shakur SF, Takagi I, Lukas RV, Chmura S, Gajewski TF, Roitberg BZ (2012) Ocular melanoma metastasis to the cervical spine. J Clin Neurosci 19:610–611CrossRefGoogle Scholar
  20. 20.
    Sun L, Song Y, Gong Q (2013) Easily misdiagnosed delayed metastatic intraspinal extradural melanoma of the lumbar spine: a case report and review of the literature. Oncol Lett 5:1799–1802CrossRefGoogle Scholar
  21. 21.
    Yoshizaki S, Inokuchi A, Hamada T et al (2017) Primary extradural malignant melanoma of the spine: a case report. J Orthop Sci.  https://doi.org/10.1016/j.jos.2017.01.007 Google Scholar
  22. 22.
    Yu J, Zhao DD, Chen S, Zhang JM, Xu J (2012) Primary melanoma of the cervical spine with cerebral metastases: case report and review of the literature. J Int Med Res 40:1207–1215CrossRefGoogle Scholar
  23. 23.
    Shankar GM, Choi BD, Grannan BL, Oh K, Shin JH (2017) Effect of immunotherapy status on outcomes in patients with metastatic melanoma to the spine. Spine (Phila Pa 1976) 42:E721–E725CrossRefGoogle Scholar
  24. 24.
    Coit DG, Thompson JA, Algazi A et al (2016) Melanoma, version 2.2016, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw 14:450–473CrossRefGoogle Scholar
  25. 25.
    Lin P, Lin N, Teng W et al (2018) Recurrence of giant cell tumor of the spine after resection: a report of 10 Cases. Orthop Surg 10:107–114CrossRefGoogle Scholar
  26. 26.
    Tomita K, Kawahara N, Baba H, Tsuchiya H, Nagata S, Toribatake Y (1994) Total en bloc spondylectomy for solitary spinal metastases. Int Orthop 18:291–298CrossRefGoogle Scholar
  27. 27.
    Mesfin A, El DMH, Jain A, Hassanzadeh H, Kebaish KM (2015) Total en bloc spondylectomy for primary and metastatic spine tumors. Orthopedics 38:e995–e1000CrossRefGoogle Scholar
  28. 28.
    Wu Y, Lin L, Shen Y, Wu H (2018) Comparison between PD-1/PD-L1 inhibitors (nivolumab, pembrolizumab, and atezolizumab) in pre-treated NSCLC patients: evidence from a Bayesian network model. Int J Cancer 143:3038–3040Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Orthopedic Oncology Center, Department of Orthopedics, Changzheng HospitalSecond Military Medical UniversityShanghaiChina

Personalised recommendations