bims-rebome 2026-10-25 papers

Spine Surg Relat Res. 2026 Sep 27. 10(5): 780-786

Effectiveness of a Specialized Outpatient Clinic on Bone Metastasis for Spine Surgeons Based on a Long-Term Follow-Up Evaluation.

Hiroyuki Tsuchie, Yuichi Ono, Shohei Murata, Michio Hongo, Yuji Kasukawa, Daisuke Kudo, Ryota Kimura, Naohisa Miyakoshi.

Introduction: Advances in cancer treatment have improved the prognosis of patients with advanced cancer, and the number of patients with bone metastases is increasing. Early interventions, such as a multidisciplinary approach and a specialized outpatient clinic for bone metastasis (SOCBM), are important to prevent fractures and nerve disorders. However, few studies have directly compared the effectiveness of these measures before and after their initiation. We aimed to analyze the usefulness of SOCBM and its impact on spine surgeons in a larger number of cases.
Methods: We included 70 patients with vertebral metastases of carcinoma who underwent surgical treatment performed by spine surgeons. We divided the patients into two groups: before and after the SOCBM was initiated (pre and post groups), and compared their clinical characteristics and surgical information.
Results: In all patients and in those treated for primary tumors at our hospital, the post group demonstrated a longer period from spine surgeon consultation to surgery than the pre group (p=0.0369 and p=0.0111, respectively). Additionally, the proportion of patients leaving the operating room after 8 pm was significantly lower in the post group (p=0.0471). Multivariate logistic regression analysis revealed that the period from spine surgeon consultation to surgery and leaving the operating room after 8 pm were significantly associated with SOCBM visits (p=0.0118 and p=0.0270, respectively).
Conclusions: SOCBM reduces the burden on spine surgeons by providing a margin before surgery for patients with spinal metastasis and by reducing delays for surgical management.

Keywords: bone metastasis; outpatient clinic; spine surgeons; surgery

DOI: https://doi.org/10.22603/ssrr.2025-0341

Spine (Phila Pa 1976). 2026 Oct 22.

Immortal Time Bias and Molecular Heterogeneity: Reassessing Lung Cancer Spinal Metastases Survival.

Yang Bai.

Keywords: immortal time bias; immunotherapy; lung cancer; precision oncology; spinal metastases

DOI: https://doi.org/10.1097/BRS.0000000000005909

J Bone Oncol. 2026 Dec;61 100806

Efficacy of immune-oncology combinations versus sunitinib in patients with bone metastases from renal cell carcinoma: A systematic review and meta-analysis of phase III trials with long-term follow-up.

Clara Fish Araujo de Albuquerque, Leila Caroline Souza Reis, Eliza Del Fiol Manna, Ana Elisa Saragossa Zafalon, Angela Theresa Zuffo Yabrude, Camillo Porta.

Background: Bone metastases occur in approximately one-third of patients with metastatic clear-cell renal cell carcinoma (ccRCC) and are associated with poor prognosis. Although immune-oncology (IO)-based combinations are the standard first-line treatment, the relative efficacy of IO plus tyrosine kinase inhibitor (IO+TKI) versus dual immunotherapy (IO+IO) in this subgroup remains uncertain.
Methods: We performed a systematic review and meta-analysis of phase III randomized trials comparing first-line IO-based combinations with sunitinib in treatment-naïve metastatic ccRCC. Eligible studies reported hazard ratios (HRs) for progression-free survival (PFS) and/or overall survival (OS) in patients with baseline bone metastases and had a median follow-up of at least 36 months. The primary analysis pooled IO+TKI trials, whereas the single eligible IO+IO study was analyzed separately. Fixed- and random-effects inverse-variance models were applied.
Results: Three phase III trials were included: CLEAR (lenvatinib plus pembrolizumab versus sunitinib), CheckMate 9ER (nivolumab plus cabozantinib versus sunitinib), and CheckMate 214 (nivolumab plus ipilimumab versus sunitinib). IO+TKI significantly improved PFS versus sunitinib (HR 0.46, 95% CI 0.35-0.61; p < 0.0001), with no heterogeneity (I2 = 0%). In contrast, IO+IO showed no PFS benefit (HR 1.07, 95% CI 0.76-1.51). Pooling all trials introduced substantial heterogeneity (I2 = 85.9%), and subgroup analysis confirmed a significant interaction between treatment class and PFS (p = 0.0002). IO+TKI also improved OS (HR 0.66, 95% CI 0.50-0.88; p = 0.0041), again without heterogeneity (I2 = 0%). IO+IO showed a non-significant trend toward improved OS (HR 0.82, 95% CI 0.61-1.11), with no significant difference between treatment classes for OS (p = 0.314).
Conclusions: In patients with metastatic ccRCC and bone metastases, IO+TKI combinations were associated with significant improvements in PFS and OS compared with sunitinib, whereas IO+IO did not improve PFS. These findings suggest that treatment strategy may influence outcomes in this high-risk subgroup.

Keywords: Bone metastases; First-line therapy; Immune checkpoint inhibitors; Meta-analysis; Metastatic renal cell carcinoma; Systematic review; Tyrosine kinase inhibitors

DOI: https://doi.org/10.1016/j.jbo.2026.100806

Spine (Phila Pa 1976). 2026 Oct 19.

Neurologic Recovery After Metastatic Spine Tumor Surgery for Spinal Cord Compression: Can Unsupervised Machine Learning Identify Recovery Patterns?

Clayton R Baker, Harsh Jain, Nick De Oliveira, Sameer Sundrani, Jeremia Williams, Albert Cordoves, Hani Chanbour, Gabrielle Santangelo, Bayard Wilson, Richard Berkman, Amir M Abtahi, Byron F Stephens, Scott L Zuckerman.

STUDY DESIGN: Retrospective Cohort Study.
OBJECTIVE: To use unsupervised machine learning to identify preoperative phenotypes among patients undergoing surgery for metastatic epidural spinal cord compression (MESCC) and evaluate whether these phenotypes stratify postoperative neurologic recovery.
SUMMARY OF BACKGROUND DATA: MESCC frequently presents with neurologic deficits, but recovery after separation surgery is variable. Most prior work has evaluated individual predictors in isolation.
METHODS: Adults undergoing surgery (2010-21) for MESCC with preoperative motor deficits were included. Latent profile analysis clustered patients on preoperative upper and lower motor scores, deficit duration, and sensory deficits. The primary outcome was postoperative motor improvement, reported as any improvement and the proportion achieving ≥25%, ≥50%, ≥75% and 100% recovery and absolute motor change. Groups were compared with ANOVA and chi-square tests, and with multivariable models adjusted for age, sex, and tumor location.
RESULTS: Among 101 patients (mean age: 60.7±10.9 years, 61.4% males), 72 (71.3%) patients had any postoperative improvement. Four clinically relevant phenotypes were identified: - Grade-1: acute, mild deficit without sensory loss, n=36. - Grade-2: acute, mild deficit with sensory loss, n=26. - Grade-3: chronic, mild deficit without sensory loss, n=20. Grade-4: chronic, severe deficit with sensory loss, n=19. Rates of any postoperative improvement were similar between Grades (P=0.479), as was percent of motor recovery (P=0.109). Grades differed in absolute motor change (P=0.028) and rates of patients achieving ≥50% (P=0.004), ≥75% (P=0.014), and 100% (P=0.004) recovery. Rates of ≥75% and 100% recovery were lowest in Grade-3 (30.0%, 30.0%) and Grade-4 (21.1%,5.3%), and Grade-4 independently predicted lower recovery after adjustment. Mortality did not differ between Grades.
CONCLUSION: Unsupervised clustering identified four preoperative phenotypes of MESCC patients that stratified clinically meaningful motor recovery and summarized neurologic presentation. This framework supports tailored, multidisciplinary counseling.
LEVEL OF EVIDENCE: 3.

Keywords: machine learning; metastatic epidural spinal cord compression; motor recovery

DOI: https://doi.org/10.1097/BRS.0000000000005906

Bioconjug Chem. 2026 Oct 21. 37(10): 1943-1948

Bone-Targeting Antibodies for Skeletal Precision Therapy.

Boyang Zhou, Han Xiao.

Therapeutic antibodies have transformed the treatment of cancer, inflammation, infection, and disorders of bone biology by recognizing disease-associated molecular targets with high specificity. However, achieving therapeutically effective antibody concentrations at the site of disease remains a major challenge, as systemic administration does not inherently result in efficient tissue-specific delivery. Bone is a particularly demanding destination because mineralized matrix, limited vascular access, marrow complexity, and active remodeling can restrict local antibody exposure. Recent advances in bone-targeting antibody design point to a powerful reframing in which antibodies can be engineered not only for antigen specificity but also for tissue specificity. By attaching hydroxyapatite-binding motifs such as bisphosphonates or acidic peptides, antibodies can be endowed with bone-homing capabilities. The efficacy of this strategy has now been validated across multiple preclinical disease models, including breast cancer bone metastasis and osteoporosis-related bone loss. The next challenge is to define how affinity, valency, conjugation site, circulation time, and release should be tuned for each skeletal disease.

DOI: https://doi.org/10.1021/acs.bioconjchem.6c00415