THE IMPACT OF TARGETED THERAPY ON SURVIVAL AFTER SPINE METASTASIS: A SYSTEMATIC REVIEW AND POOLED DATA ANALYSIS
Bibliographic record
Abstract
Tumor specific targeted immunotherapy has substantially impacted the quality and quantity of life for patients with spinal metastatic malignancies. Numerous scoring utilities such as the Tokuhashi, Tomita or Spinal Instability Neoplastic score (SINS) are often used to prognosticate treatment and guide surgical management. However, many of these scoring systems are potentially outdated and do not reflect the recent advances made in medical oncology and targeted therapeutic treatment. The primary aim of this research was to investigate the current state of the literature and treatment options pertaining to advancements in targeted systemic therapy compared to other forms of medical management for metastatic spinal tumors. A systematic literature review and pooled data analysis were performed to evaluate the median overall survival (mOS) for patients with metastatic spinal tumors originating from five (lung, breast, renal, melanoma, thyroid) common primary cancers. A comprehensive search of PubMed was conducted by two authors to identify relevant articles for review. Following PRISMA guidelines, 28 of 1834 initially identified articles met our inclusion criteria, encompassing the five primary tumor locations. Lung cancer articles (n=16) reported a weighted mOS of 6.8 months, while articles on breast cancer (n=5) showed 24.0 months, renal cancer (n=3) demonstrated 58.1 months, and thyroid cancer (n=1) exhibited 123.0 months. 15/16 identified articles on lung cancer with spinal metastases included targeted therapy (TT), primarily utilizing EGFR-TKI, resulting in significant improvements in mOS (21.0 months) compared to those without TT (5.65 months). Six of these articles reported statistically significant (p < 0 .05) hazard ratios (HR), and the pooled HR was found to be 0.486. Breast cancer patients who received TT also had a higher overall mOS (83.2 months) compared to those without TT (overall mOS = 32.86). All three melanoma papers reported patients receiving TT, with two showing a mOS improvement, and notably, one paper indicated significance thereof (HR: 0.32, CI: 0.17-0.58, p=0.0002). Of all included articles, only five studies utilized bisphosphonate therapy. Among these, four demonstrated an extension in mOS when compared to non-treatment groups, with three of them showing statistically significant improvements (p < 0 .05). Among the five lung cancer papers that reported outcomes for both chemotherapy and non-chemotherapy groups, four indicated higher mOS with chemotherapy, with one showing statistical significance (p < 0 .001). Similarly, the breast cancer paper reporting chemotherapy outcomes demonstrated a significant mOS improvement (p=0.013). Articles were excluded if they did not consistently report chemotherapy use or provide survival outcomes. Based on this review and pooled data analysis, targeted therapy, especially in lung and breast cancers, demonstrated the most notable improvements in mOS. Our study provides valuable insights into the recent advancement of medical management of metastatic spinal tumors. Future indications include incorporating this literature into personalized treatment approaches to metastatic spine tumors.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".