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Tumor-specific outcomes in spinal metastases: a systematic review and meta-analysis
Vivek Sanker1, Emil O R Nordin1, Anam Sayed Mushir Ali2
1Department of Neurosurgery, Stanford University, Stanford, CA, USA.
Background:
Spinal metastases (SMs) are common, debilitating, and often associated with severe pain and neurologic disability. Treatment decisions hinge on anticipated life expectancy, yet survival and recurrence outcomes remain poorly defined across primary tumor types. This study is to systematically review and meta-analyze outcomes of SM stratified by primary cancer, with focus on survival, recurrence, and treatment patterns.
Methods:
PubMed, Scopus, Web of Science Core Collection, and Embase (Ovid) were searched from inception to April 16, 2025. Eligible studies reported outcomes in patients with SM from any primary tumor. Random-effects meta-analyses were performed for survival and recurrence. Study quality was assessed with ROBINS-I.
Results:
One hundred twenty-three studies (38,780 patients) across nine primary tumors were included; 61 studies (9,222 patients) contributed to meta-analysis. Lung cancer accounted for the largest cohort (n=26,918), followed by gynecologic (n=3,679), breast (n=1,961), and renal (n=1,732). Pooled 1-year survival ranged from 46% in lung SM to 74% in prostate SM. Median survival was shortest for liver (8.2 months) and lung (12.1 months), and longest for thyroid (59.9 months) and melanoma (57.9 months). Recurrence rates were consistently low (<5%), though thyroid SM carried a slightly higher long-term risk.
Conclusions:
Outcomes in SMs are strongly influenced by primary tumor biology. These data provide benchmarks for clinical decision-making and highlight the need for prospective studies integrating molecular and functional outcomes.
