bims-rebome 2026-07-19 papers

Urol Oncol. 2026 Jul 12. pii: S1078-1439(26)00576-4. [Epub ahead of print]

Impact of number of bone metastases on cancer control outcomes in mHSPC, independent of the axial-skeleton CHAARTED definition.

Mike Wenzel, Lena Theissen, Carolin Siech, Benedikt Lauer, Sophia Winkler, Maximilian Filzmayer, Chi Le, Clara Humke, Maximilian Kriegmair, Thomas Steuber, Felix K H Chun, Philipp Mandel.

OBJECTIVE: Patient and treatment stratification for metastatic hormone-sensitive prostate cancer (mHSPC) is usually based on metastatic burden according to CHAARTED criteria, classifying high-volume disease as at least 4 bone metastases, one outside the axial skeleton, or one visceral metastasis. We aimed to examine the impact of the number of bone metastases independently of CHAARTED criteria.
MATERIAL AND METHODS: Using the FRAMCAP (FRAnkfurt Metastatic Cancer database of the Prostate), time to castration resistant prostate cancer (ttCRPC) and overall survival (OS) were analyzed in patients with mHSPC stratified into 1 to 3 vs. 4 to 7 vs. ≥8 bone metastases, irrespective of axial skeletal location. Comparisons were made against CHAARTED low- and high-volume mHSPC outcomes.
RESULTS: Of 398 patients with mHSPC, 43% harbored 1 to 3, 19% 4 to 7 and 38% ≥8 bone metastases. CHAARTED high-volume mHSPC was diagnosed in 52%. Median ttCRPC was lowest for ≥8 bone metastases (16.2 months), followed by 4 to 7 (17.3 months) and 1 to 3 bone metastases (28.4 months; P < 0.01). Similar ttCRPC outcomes were observed when stratification was made into CHAARTED low- (28.4 months) vs. high-volume mHSPC (17.2 months). Median OS was also significantly shorter for ≥8 bone metastases (34.5 months), followed by 4 to 7 (53.3 months), and 1 to 3 (56.4 months; P < 0.001). Comparable OS outcomes were observed in CHAARTED low- (58.3 months) vs. high-volume mHSPC (43.4 months).
CONCLUSION: The number of bone metastases, regardless of their localization in the axial skeleton, has a significant influence on cancer-control outcomes. Especially, patients with ≥4 bone metastases have comparable outcomes to CHAARTED high-volume patients with mHSPC with at least one metastasis outside the axial skeleton.

Keywords: Bone; MHSPC; Metastatic burden; Osseous; Survival rate

DOI: https://doi.org/10.1016/j.urolonc.2026.06.018

J Bone Oncol. 2026 Aug;59 100782

Clinical applications of MRI-based artificial intelligence in spinal metastases: A systematic review.

Chunhua Hou, Anqi Wang, Jianru Xiao, Xiang Wang, Wei Xu.

Objective: This review systematically evaluates the current research landscape, methodological characteristics, and translational challenges of artificial intelligence (AI) integrated with magnetic resonance imaging (MRI) across the diagnostic and therapeutic pathway of spinal metastases, with the aim of informing clinical practice and future research.
Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic search of PubMed, Web of Science, and the Cochrane Library. Original studies investigating AI models, including machine learning, deep learning, and large language models, developed from MRI data for spinal metastases were included. Two reviewers independently screened studies and extracted data. Sixty-one studies were included in the qualitative synthesis.
Results: The included studies focused on four core clinical tasks: diagnosis and pathological classification (23 studies), clinical prognosis and risk stratification (17 studies), lesion detection and segmentation (16 studies), and automated clinical scoring and report analysis (5 studies). AI models showed promising performance across these tasks, with the highest area under the curve (AUC) for benign-malignant differentiation reaching 0.98 and the highest Dice similarity coefficient (DSC) for automatic lesion segmentation exceeding 0.85. Nevertheless, important limitations remain. Most studies were single-center retrospective investigations (73%), and the majority addressed isolated tasks rather than integrated clinical workflows. Important gaps also persist in multicenter generalizability, long-term survival prediction, and multimodal data integration.
Conclusion: MRI-based AI has substantial potential to improve the diagnosis and management of spinal metastases. Future studies should emphasize large-scale, multi-center prospective validation and integrated intelligent systems supporting screening, decision-making, treatment response assessment, and long-term follow-up.

Keywords: Artificial intelligence; Deep learning; Magnetic resonance imaging; Radiomics; Spinal metastases; Systematic review

DOI: https://doi.org/10.1016/j.jbo.2026.100782

Transl Cancer Res. 2026 Jun 30. 15(6): 487

Efficacy and safety of combined RANKL and PD-1 inhibitors in bone metastases: a retrospective study.

Wei Zhou, Yuehong Kong, Shicheng Li, Xiangrong Zhao, Liyuan Zhang.

Background: RANKL inhibitors can inhibit the formation and functional activation of osteoclasts, providing osteoprotective effects. Recent findings indicate that RANKL inhibitors also exhibit immunomodulatory effects within the tumor microenvironment (TME). Both RANKL and programmed cell death protein 1 (PD-1) inhibitors modulate immune responses, raising concerns about the potential for overactivation of the immune system and increased adverse reactions when used together.We conducted a retrospective analysis to evaluate the safety and efficacy of combined RANKL and PD-1 inhibitor therapy in patients with bone metastases, and to explore its effects on immune response.
Methods: This retrospective analysis included patients with bone metastases from malignant tumors who were treated with a combination of RANKL inhibitors and PD-1 inhibitors. Treatment response was evaluated using the RECIST 1.1 criteria, and toxicity was assessed using the CTCAE 5.0 criteria. Survival curves were plotted using the Kaplan-Meier method, and differences in survival between groups were compared using the Log-Rank test; Cox regression models were used to analyze prognostic risk factors; and the Kruskal-Wallis test, univariate analysis of variance, chi-square test, and Fisher's exact test were used to compare baseline characteristics among the complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) groups.
Results: The combination demonstrated an acceptable safety profile, with grade ≥3 treatment-related adverse events (TRAEs) reported in 10 patients (11.4%), including one case of treatment-related immune-related encephalitis leading to death (1.1%). Among 88 patients included, the overall response rate (ORR) was 17.0%, and the disease control rate (DCR) was 53.4%. The median progression-free survival (PFS) was 5.90 months [95% confidence interval (CI): 5.13-6.67], and the median overall survival (OS) was 16.10 months (95% CI: 12.67-19.53).
Conclusions: Overall, these findings indicate that the combined administration of RANKL and PD-1 inhibitors yields a manageable safety profile and preliminary signals of clinical activity in patients with bone metastases. These retrospective data are fundamentally hypothesis-generating, and rigorous prospective clinical trials remain imperative to validate the efficacy of this regimen. This study provides preliminary real-world evidence exploring the clinical feasibility of this combination therapy for advanced bone metastasis patients, though conclusions are inherently limited by its retrospective design.

Keywords: Bone metastasis; RANKL inhibitor; immunomodulation; programmed cell death protein 1 inhibitor (PD-1 inhibitor)

DOI: https://doi.org/10.21037/tcr-2026-1-0312