bims-rebome 2026-01-25 papers

J Neurosurg Spine. 2026 Jan 09. 1-10

Influence of socioeconomic status on health outcomes after treatment of spinal metastases.

Husain Shakil, Armaan K Malhotra, Adom Bondzi-Simpson, Ahmad Essa, Vishwathsen Karthikeyan, Christopher S Lozano, Anne L Versteeg, Christopher W Smith, Yingshi He, Jetan H Badhiwala, Arjun Sahgal, Nicolas Dea, Michael G Fehlings, Alexander Kiss, Christopher D Witiw, Donald A Redelmeier, Jefferson R Wilson.

OBJECTIVE: The aim of this study was to investigate the association of home socioeconomic status (SES) with days at home and survival after treatment of spinal metastases.
METHODS: This population cohort study included all patients in the Ontario Cancer Registry treated from 2007 to 2019 with surgery or radiation therapy (RT) for spinal metastasis. Ordinal categories of SES (SES1-SES5) were defined using home neighborhood material deprivation scores. Outcomes included adjusted median differences (aMD) in the number of days at home and adjusted hazard ratios (aHRs) of mortality for patients of differing SES. Secondary care access outcomes included receiving stereotactic body RT for treatment, the timing of palliative care initiation, and the distance from home to the nearest cancer center.
RESULTS: There were 35,896 patients (55% male, mean age 64.4 years) identified; 7397 (21%) resided in relatively resource-deprived neighborhoods and 7080 (20%) resided in relatively resource-affluent neighborhoods. Patients living in the lowest SES neighborhoods had the fewest days at home (SES1 vs SES5, aMD -47) and shortest survival (SES1 vs SES5, aHR 1.14). There was significant mediation attributable to differences in primary cancer (days at home [15.6%], survival [25.7%]) and frailty (days at home [5.9%], survival [7.7%]) between neighborhood SES. Patients residing in lower SES neighborhoods were less often treated with stereotactic body RT (adjusted OR 0.38), had later initiation of palliative care (aHR 0.94), and lived farther from cancer centers (adjusted mean difference 16.5 km).
CONCLUSIONS: Patients with spinal metastases living in lower SES neighborhoods had fewer days at home and shorter survival, which was partially mediated by differences in primary cancer and possibly posttreatment access to oncology care. These findings will support advocacy efforts championing equity in cancer care.

Keywords: cohort studies; material deprivation; oncology; outcome disparities; socioeconomic status; spinal metastasis; tumor

DOI: https://doi.org/10.3171/2025.8.SPINE25567

Front Oncol. 2025 ;15 1747354

Efficacy, safety and economy of denosumab and zoledronic acid in the treatment of bone metastases of solid tumors and multiple myeloma: a systematic review and meta-analysis.

Li Zhong, Wei Chen, Da Zheng, Yuening Cao, Ling Zhu, Zefeng Zhu, Luqin Liao, Lilin Dai, Xiaotao Wang, Zheng Zeng.

Objective: To conduct a comprehensive comparison of the efficacy, safety, and cost-effectiveness of denosumab versus zoledronic acid in patients with bone metastases from solid tumors and multiple myeloma.
Methods: A systematic search of PubMed, Web of Science, Embase, and major Chinese databases was performed for studies published up to 30 September 2025. Eligible evidence included randomized controlled trials, cohort studies, and pharmacoeconomic analyses. Random-effects models were applied for quantitative synthesis. The certainty of evidence for key outcomes was assessed using the GRADE framework.
Results: Twenty-one studies were included. Moderate-certainty evidence indicates that denosumab likely delays the time to first skeletal-related event (SRE) (HR = 0.85, 95% CI: 0.79-0.93) and time to first and subsequent SREs (HR = 0.86, 95% CI: 0.76-0.97) relative to zoledronic acid. Subgroup analyses demonstrated that this benefit is pronounced in solid tumors but not observed in multiple myeloma. For survival outcomes, moderate-certainty evidence suggests little to no difference in overall survival (HR = 0.97, P = 0.49) or progression-free survival (HR = 0.99, P = 0.86). Low-certainty evidence suggests that denosumab may reduce the risk of any adverse events (OR = 0.70, P = 0.04) and nephrotoxicity (OR = 0.65, P = 0.02). Pharmacoeconomic evaluations revealed marked geographic heterogeneity: denosumab was generally cost-effective in high-income settings with higher willingness-to-pay thresholds, whereas in resource-limited regions, zoledronic acid remained the more economically favorable option.
Conclusion: Denosumab probably confers superior protection against SREs in patients with solid tumors and demonstrates a potentially improved renal safety profile compared with zoledronic acid. However, its cost-effectiveness varies substantially across healthcare systems and is strongly shaped by regional pricing structures and willingness-to-pay thresholds. Clinical adoption should therefore consider tumor biology, safety characteristics, and local economic capacity.
Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD420251020691.

Keywords: bone metastases; denosumab; meta-analysis; skeletal-related events; systematic review; zoledronic acid

DOI: https://doi.org/10.3389/fonc.2025.1747354

J Orthop Sci. 2026 Jan 21. pii: S0949-2658(26)00004-7. [Epub ahead of print]

Prognostic scoring systems reflect the prognosis of patients with metastatic spinal tumors who underwent spinal surgery in recent cases: JASA multicenter prospective study.

Masahiro Iinuma, Takeo Furuya, Yuki Shiratani, Akinobu Suzuki, Hidetomi Terai, Takaki Shimizu, Kenichiro Kakutani, Yutaro Kanda, Hiroyuki Tominaga, Ichiro Kawamura, Masayuki Ishihara, Masaaki Paku, Yohei Takahashi, Toru Funayama, Kosei Miura, Eiki Shirasawa, Hirokazu Inoue, Atsushi Kimura, Takuya Iimura, Hiroshi Moridaira, Hideaki Nakajima, Shuji Watanabe, Koji Akeda, Norihiko Takagami, Kazuo Nakanishi, Hirokatsu Sawada, Koji Matsumoto, Masahiro Funaba, Hidenori Suzuki, Haruki Funao, Tsutomu Oshigiri, Takashi Hirai, Bungo Otsuki, Kazu Kobayakawa, Koji Uotani, Hiroaki Manabe, Shinji Tanishima, Ko Hashimoto, Chizuo Iwai, Daisuke Yamabe, Akihiko Hiyama, Shoji Seki, Yuta Goto, Masashi Miyazaki, Kazuyuki Watanabe, Toshio Nakamae, Takashi Kaito, Hiroaki Nakashima, Narihito Nagoshi, Satoshi Kato, Shiro Imagama, Kota Watanabe, Gen Inoue, Seiji Ohtori, Hisateru Niki.

BACKGROUND: The incidence of cancer and related deaths has increased substantially, with bone commonly serving as a metastatic site. Metastatic spinal tumors severely impair quality of life and activities of daily living. Prognostic scoring systems such as the revised Tokuhashi and Tomita scores are widely used in surgical decision-making for these tumors. However, their accuracy for recent cancer cases is unclear due to advances in cancer therapy.
METHODS: This multicenter, prospective study by the Japan Association of Spine Surgeons with Ambition analyzed 413 surgical cases for metastatic spinal tumors from October 2018 to March 2021. Of these, 272 cases with complete data were included. The Kaplan-Meier method, log-rank test, and statistical analysis were used to assess the association between survival and prognostic scores.
RESULTS: Both the revised Tokuhashi and Tomita scores significantly stratified patients by survival (P < 0.01). The revised Tokuhashi score accurately predicted survival in 60.3 % of patients, underestimated it in 33.1 %, and overestimated it in 6.6 %. Significant score differences were found among groups with different survival durations. However, differentiating between <6-month and 6-12-month survival periods was difficult.
CONCLUSIONS: The revised Tokuhashi and Tomita scores remain valid tools for predicting prognosis in patients undergoing surgery for metastatic spinal tumors. Nonetheless, these systems tend to underestimate survival in recent cases, particularly in short-term prognoses. Updating the scoring criteria may be necessary to reflect advancements in cancer therapy and extended patient survival.

Keywords: Metastatic spinal tumor; Prognostic scoring systems; Revised Tokuhashi score; Surgical treatment; Tomita score

DOI: https://doi.org/10.1016/j.jos.2026.01.003