Population-Based Survival Analysis of Solitary Plasmacytoma of Spine in the United States From 2000 to 2020

Abstract

Background

Solitary plasmacytomas of bone of the spine (SPBS) are rare tumors associated with significant morbidity and mortality, especially with progression to multiple myeloma.

Aims

While demographic and treatment factors influencing survival have been investigated in previous studies, analysis using the most recent population data and assessing more granular data such as the extent of surgical resection in conjunction with radiotherapy has yet to be performed.

Methods

The Surveillance, Epidemiology, and End Results (SEER) Program was queried for patients with a diagnosis of SPBS (ICD-0-3 code 9731/3). Demographic and treatment variables were analyzed using Cox regression, and a log-rank analysis was used to assess 5-year overall survival (5y OS).

Results

A total of 1391 patients diagnosed with localized SPBS were identified. Multivariate analysis revealed that increasing age at diagnosis (HR = 2.25, p < 0.001) and higher income (HR = 1.471; p < 0.001) were significantly associated with decreased 5y OS, while being married was associated with improved survival (HR = 0.671, p < 0.001). Furthermore, treatment with radiation therapy (HR = 0.613, p < 0.001) and gross total resection (HR = 0.657; p = 0.020) were associated with improved survival outcomes. Univariate analysis confirmed the demographic factor significance, with radiotherapy combined with surgery being associated with improved survival versus sole radiotherapy (49.4% vs. 40.8%; p = 0.004).

Conclusion

This population-based analysis of SPBS highlights key prognostic factors for 5y OS. Increased age, higher income, and single marital status were associated with worse outcomes, while radiation therapy and greater extent of surgical procedure improved survival. Notably, radiotherapy combined with surgery showed better survival than radiation alone, challenging current national guidelines that recommend radiotherapy with or without surgery. Additionally, gross total resection demonstrated the highest overall survival among the various surgical procedures. These findings suggest that incorporating combined therapy into treatment protocols could improve outcomes and refine future guidelines.