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Background <p>Breast cancer spinal metastases present a growing clinical challenge, with survival outcomes varying significantly by immunohistochemistry-based subtype. Current prognostic models often overlook subtype-specific differences, potentially leading to suboptimal treatment decisions. This study aimed to establish the first comprehensive subtype-specific survival benchmarks for spinal metastases and to evaluate temporal trends in survival.</p> Methods <p>We conducted a systematic review and meta-analysis of survival outcomes following a predefined protocol (PROSPERO CRD42024580279). Eligible studies reported overall survival (OS) in patients with breast cancer spinal metastases, stratified by immunohistochemistry-based subtype: hormone receptor (HR +), human epidermal growth factor receptor 2-enriched (HER2 +), and triple-negative breast cancer (TNBC). Survival data were extracted from published figures with a digitizer program and then processed in R. The median OS was analyzed through pooled survival curves with 95% confidence intervals, compared via log-rank tests. To evaluate temporal trends, we performed era-stratified analyses (pre-2000, 2000–2019, post-2020) using chronological partitioning of study enrollment periods.</p> Results <p>After screening 2,348 records, we identified seven eligible cohorts comprising 672 patients. Analysis revealed significant survival differences among subtypes (log-rank <i>p</i> &lt; 0.0001), with median OS of 28.9&#xa0;months (95% CI 26.0–35.6; <i>n</i> = 347) for HR + , 43.7&#xa0;months (31.9–48.7; <i>n</i> = 244) for HER2 + , and 10.7&#xa0;months (8.9–19.2; <i>n</i> = 81) for TNBC (very low certainty of evidence for all outcomes). Temporal analysis of 4464 patients from 61 studies demonstrated significant survival improvements post-2020 (log-rank <i>p</i> &lt; 0.0001).</p> Conclusions <p>This study establishes the first real-world unadjusted survival reference for subtypes in breast cancer spinal metastases, suggesting a potential survival advantage of HER2 + /HR + over HER2 + /HR − tumors. These findings underscore the essential role of subtyping in refining prognostic assessment for spinal metastases. Our findings demonstrate a temporal improvement in survival and highlight the persistent need for contemporary data in this rapidly evolving clinical landscape.</p> Trial registration <p>PROSPERO CRD42024580279.</p>

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The influence of immunohistochemistry-based subtypes on overall survival in breast cancer spine metastases: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月21日

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  • Fon-Yih Tsuang,
  • Yun-Heng Li,
  • Ting-Li Shen,
  • Chiun-Sheng Huang,
  • Chung Liang Chai

摘要

Background

Breast cancer spinal metastases present a growing clinical challenge, with survival outcomes varying significantly by immunohistochemistry-based subtype. Current prognostic models often overlook subtype-specific differences, potentially leading to suboptimal treatment decisions. This study aimed to establish the first comprehensive subtype-specific survival benchmarks for spinal metastases and to evaluate temporal trends in survival.

Methods

We conducted a systematic review and meta-analysis of survival outcomes following a predefined protocol (PROSPERO CRD42024580279). Eligible studies reported overall survival (OS) in patients with breast cancer spinal metastases, stratified by immunohistochemistry-based subtype: hormone receptor (HR +), human epidermal growth factor receptor 2-enriched (HER2 +), and triple-negative breast cancer (TNBC). Survival data were extracted from published figures with a digitizer program and then processed in R. The median OS was analyzed through pooled survival curves with 95% confidence intervals, compared via log-rank tests. To evaluate temporal trends, we performed era-stratified analyses (pre-2000, 2000–2019, post-2020) using chronological partitioning of study enrollment periods.

Results

After screening 2,348 records, we identified seven eligible cohorts comprising 672 patients. Analysis revealed significant survival differences among subtypes (log-rank p < 0.0001), with median OS of 28.9 months (95% CI 26.0–35.6; n = 347) for HR + , 43.7 months (31.9–48.7; n = 244) for HER2 + , and 10.7 months (8.9–19.2; n = 81) for TNBC (very low certainty of evidence for all outcomes). Temporal analysis of 4464 patients from 61 studies demonstrated significant survival improvements post-2020 (log-rank p < 0.0001).

Conclusions

This study establishes the first real-world unadjusted survival reference for subtypes in breast cancer spinal metastases, suggesting a potential survival advantage of HER2 + /HR + over HER2 + /HR − tumors. These findings underscore the essential role of subtyping in refining prognostic assessment for spinal metastases. Our findings demonstrate a temporal improvement in survival and highlight the persistent need for contemporary data in this rapidly evolving clinical landscape.

Trial registration

PROSPERO CRD42024580279.