bims-rebome Biomed News
on Management of bone metastases
Issue of 2026–09–20
nine papers selected by
Alberto Selvanetti, Azienda Ospedaliera San Giovanni Addolorata
  1. Editorial: Bone metastases in endocrine cancers: advances in diagnosis, treatment, and prevention.
  2. The value of 18F-fluoride PET in bone metastases: an overview.
  3. Artificial Intelligence for Detection and Characterisation of Bone Metastases on MRI: A Scoping Review.
  4. Beyond albumin: a systematic review, meta-analysis, and GRADE assessment of seven preoperative nutritional and inflammatory biomarkers in metastatic spine surgery.
  5. Outcomes of Percutaneous Stabilization for Pelvic Metastatic Bone Disease: A Systematic Review and Meta-Analysis.
  6. Impact of Surgical Planning Status on Survival, Complications, Resource Utilization, and Functional Outcomes of Metastatic Spine Tumor Surgery: Systematic Review.
  7. Impact of inflammatory bowel disease on perioperative complications in patients undergoing surgery for metastatic spinal tumors.
  8. Current Trends in Therapeutic Outcomes Among Patients With Metastatic Renal Cell Carcinoma of the Spine: A Systematic Review and Meta-Analysis.
  9. Assessment of Bone Metastases, Skeletal-Related Events and Bone-Targeting Agents in Patients With Metastatic Renal Cell Carcinoma Receiving First-Line Systemic Therapy (Meet-URO 33 Study Subanalysis).
  1. Front Endocrinol (Lausanne). 2026 ;17 1953774
    Editorial: Bone metastases in endocrine cancers: advances in diagnosis, treatment, and prevention.
    Chandi C Mandal, Julie A Rhoades.
      
    Keywords:  advanced imaging; biochemical/molecular markers; bone metastases (BM); endocrine cancer; skeletal complications
    DOI:  https://doi.org/10.3389/fendo.2026.1953774
  2. Semin Nucl Med. 2026 Sep 17. pii: S0001-2998(26)00181-9. [Epub ahead of print]
    The value of 18F-fluoride PET in bone metastases: an overview.
    Caroline Torricelli, Ellen Nogueira-Lima, Elba Etchebehere.
      Bone metastases are a major cause of morbidity in patients with advanced cancer, making accurate detection essential for staging, treatment planning, and response assessment. Among molecular imaging techniques, 18F-sodium fluoride (18F-NaF) PET/CT is one of the most sensitive modalities for evaluating osteoblastic skeletal metastases because of its rapid blood clearance and high bone uptake identifying areas of increased bone remodeling associated with metastatic disease. Despite its excellent diagnostic performance, the clinical role of 18F-NaF PET/CT has evolved with the emergence of disease-specific PET radiotracers and advances in hybrid imaging. This review provides a comprehensive overview of the biological basis and imaging principles of 18F-NaF PET/CT, followed by comparison with other imaging modalities, including conventional bone scintigraphy, SPECT/CT, CT, whole-body MRI and other PET/CT tracers, highlighting the advantages and limitations of each modality. Clinical applications of 18F-NaF PET/CT in bone metastatic disease is discussed across malignancies. Limitations and pitfalls relevant to interpretation and clinical use of 18F-NaF PET/CT are reviewed, including false-positive and false-negative findings, artifacts, the flare phenomenon, cost and limited availability, and radiation dose considerations. Finally, advances in quantitative PET imaging, artificial intelligence, and hybrid imaging are discussed as promising tools to improve the diagnostic performance and clinical utility of 18F-NaF PET/CT. This review highlights the current evidence supporting the use of 18F-NaF PET/CT and discusses its evolving role in the imaging evaluation of bone metastases.
    Keywords:  (18)F-sodium fluoride; Bone metastases; Hybrid imaging; Molecular imaging; PET/CT; Treatment response
    DOI:  https://doi.org/10.1053/j.semnuclmed.2026.08.011
  3. Cancers (Basel). 2026 Aug 28. pii: 2794. [Epub ahead of print]18(17):
    Artificial Intelligence for Detection and Characterisation of Bone Metastases on MRI: A Scoping Review.
    Juncheng Huang, Wilson Ong Ying Fa, Aric Lee Wei Zheng, Timothy Shao Ern Tan, Gordan Toh Cheong Zheng, Ee Chin Teo, Jiong Hao Jonathan Tan, Naresh Kumar, James T P D Hallinan.
      Background/Objectives: Bone metastasis is one of the most common manifestations of advanced malignancy and a major cause of morbidity, particularly when involving the spine. Magnetic resonance imaging (MRI) plays a central role in its detection and characterisation due to its high sensitivity for bone marrow infiltration. However, bone metastases may be missed on MRI, whilst interpretation can be time-consuming and challenging. The purpose of this study is to review and summarise the present evidence for artificial intelligence (AI) applications in the detection and classification of bone metastasis on MRI. Methods: A systematic, detailed search of the main electronic medical databases (PubMed, MEDLINE, Web of Science, and clinicaltrials.gov, last accessed on 1 January 2026) was undertaken in concordance with the PRISMA guidelines. Results: A total of 34 studies were included. AI applications were identified across several domains, including lesion detection, segmentation, disease classification, and predictive modelling. Deep learning approaches demonstrated strong performance for automated detection and segmentation, while radiomics-based models were frequently used for lesion differentiation and prediction tasks. Reported performance metrics were generally high, with area under the curve values commonly ranging from approximately 0.72-0.94, with most studies reporting AUCs exceeding 0.80 in internal validation, although substantial heterogeneity in study design, datasets, and validation strategies was observed. External validation and prospective evaluation were limited across most studies. Conclusions: Within the domain of bone metastasis, AI-based approaches have demonstrated encouraging performance and hold substantial potential to support clinical decision-making, including prognostication and prediction of treatment response. Nevertheless, further research is required to validate their clinical utility and to facilitate successful integration into routine clinical practice.
    Keywords:  artificial intelligence; bone metastasis; machine learning; magnetic resonance imaging
    DOI:  https://doi.org/10.3390/cancers18172794
  4. Eur Spine J. 2026 Sep 14.
    Beyond albumin: a systematic review, meta-analysis, and GRADE assessment of seven preoperative nutritional and inflammatory biomarkers in metastatic spine surgery.
    Ying-Ching Li, Cheng-Yu Li, Sheng-Han Huang, Hong-Kai Wang, Kuan-Hung Chen, Yan-Po Kang, Peng-Wei Hsu, Yu-Jen Lu.
       PURPOSE: To evaluate the prognostic value of preoperative nutritional and inflammatory biomarkers-including serum albumin, prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), modified Glasgow Prognostic Score (mGPS), systemic immune-inflammation index (SII), and C-reactive protein/albumin ratio (CAR)-for clinical outcomes following open surgery for spinal metastases.
    METHODS: A comprehensive literature search of PubMed/MEDLINE, Embase, Cochrane CENTRAL, Scopus, and Web of Science (January 2010-April 2026) identified studies of adult patients who underwent open surgery for histologically or radiologically confirmed spinal metastases and had at least one preoperative biomarker measurement. Percutaneous-only procedures were ineligible. Paired reviewers independently extracted data and appraised methodological quality (QUIPS tool). Effect estimates were pooled in DerSimonian-Laird random-effects models where at least two studies reported comparable metrics, and the certainty of evidence was graded with the GRADE framework.
    RESULTS: Fifteen studies (N = 6,253 patients; 14 retrospective cohorts, 1 prospective multicenter) met eligibility criteria. Serum albumin was consistently associated with overall survival (pooled HR = 1.88 per 1 g/dL decrease, 95%CI 1.60-2.20; I²=0%; p < 0.001; GRADE: LOW). PLR elevation was associated with worse survival (pooled HR = 1.50, 95%CI 1.22-1.85; I²=55%; p < 0.001). NLR showed a significant but substantially heterogeneous association (pooled HR = 2.40, 95%CI 1.12-5.12; I²=86%). PNI demonstrated a consistent protective association across three studies (OR range 0.86-0.93 per unit increase), though disparate effect measures (OR vs. HR) and endpoints (90-day mortality, wound complications, overall survival) precluded quantitative pooling. In the only prospective multicenter study (JASA; n = 336, 35 centres), mGPS was the sole independent nutritional predictor of 3-month mortality (OR = 1.99, 95%CI 1.21-3.48; AUC = 0.716). Hypoalbuminemia (< 3.5 g/dL) was associated with a 5-fold increase in 30-day mortality in 1,498 NSQIP patients (OR = 5.20, 95%CI 3.36-8.04).
    CONCLUSIONS: Preoperative nutritional and inflammatory biomarkers-particularly serum albumin, PNI, and mGPS-are consistently associated with outcomes following metastatic spine surgery. Although the certainty of evidence is predominantly LOW-to-VERY-LOW-reflecting observational study designs rather than inconsistent findings-the large effect magnitudes, biological plausibility, and cross-cohort consistency suggest that albumin and PNI may warrant consideration for incorporation into preoperative risk stratification. A tiered preoperative nutritional risk stratification pathway is hypothesised for future prospective validation. This pathway uses only routinely available laboratory values and can be readily implemented alongside existing prognostic scoring systems.
    Keywords:  Meta-analysis; Nutritional biomarkers; Prognostic nutritional index; Serum albumin; Spinal metastases; Systematic review
    DOI:  https://doi.org/10.1007/s00586-026-10354-z
  5. Cancers (Basel). 2026 Aug 28. pii: 2804. [Epub ahead of print]18(17):
    Outcomes of Percutaneous Stabilization for Pelvic Metastatic Bone Disease: A Systematic Review and Meta-Analysis.
    Alyssa A Federico, Zachary A Carter, Alexander W Iwasyk, Golpira Elmi Assadzadeh, Michael J Monument, Matthew G Cable, Joseph K Kendal.
       BACKGROUND/OBJECTIVES: Metastatic bone disease (MBD) of the pelvis is commonly managed with open reconstruction despite substantial morbidity and high complication rates ranging from 16-32%. Percutaneous fixation techniques have emerged as a lower morbidity alternative; however, robust evaluations of outcomes remain limited. Therefore, the primary aim of this systematic review was to evaluate changes in pain and function following percutaneous fixation for pelvic MBD, and to determine the complication and reoperation rates of these procedures.
    METHODS: A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, Embase, Scopus, and Cochrane Library databases were searched from inception through 15 May 2025. Studies evaluating percutaneous fixation for pelvic MBD in adults were included. Pooled estimates of visual analog scale (VAS) pain scores, Eastern Cooperative Oncology Group (ECOG) performance status scores, complication rates, and reoperation rates were generated using meta-analysis techniques.
    RESULTS: Twenty-five studies were included in the final analysis. VAS pain scores were reported in 15 studies, with an average decrease of 5.0 points (95% CI: 3.9-6.1) from pre- to postoperative. ECOG performance status scores were reported in 8 studies, with an average improvement of 1.1 points (95% CI: 0.7-1.5) from pre- to postoperative. Complications were reported in 24 studies, with a pooled complication rate of 8% (95% CI: 6-12%) and reoperation rate of 4% (95% CI: 2-7%).
    CONCLUSIONS: Percutaneous fixation for pelvic MBD provides meaningful improvements in pain and function with relatively low complication rates. However, substantial study heterogeneity exists in the patient population, surgical techniques, and implant selection, reflecting the novelty of this treatment strategy and the absence of standardized guidelines.
    Keywords:  complications; metastatic bone disease; minimally invasive; outcomes; pelvis; percutaneous; surgery
    DOI:  https://doi.org/10.3390/cancers18172804
  6. Spine J. 2026 Sep 12. pii: S1529-9430(26)00670-4. [Epub ahead of print]
    Impact of Surgical Planning Status on Survival, Complications, Resource Utilization, and Functional Outcomes of Metastatic Spine Tumor Surgery: Systematic Review.
    Ali Haider Bangash, Jayden Boafo, Michelle Lee, Keyvan Ghadimi, Victoria Cao, Alexander Alexandrov, Liza Belman, Sertac Kirnaz, Rose Fluss, Saikiran G Murthy, Yaroslav Gelfand, Reza Yassari, Rafael De la Garza Ramos.
       BACKGROUND CONTEXT: Metastatic spine disease presents complex surgical decision-making challenges, where patients may undergo either planned or unplanned intervention depending on clinical presentation and system-level factors. Unplanned surgery appears to be associated with more advanced disease at presentation, including neurological compromise, yet its impact on short- and long-term outcomes remains incompletely understood.
    PURPOSE: To synthesize the available evidence on the association between surgical planning status and outcomes in metastatic spine tumor surgery (MSTS) STUDY DESIGN/SETTING: Systematic review PATIENT SAMPLE: Patients managed with MSTS OUTCOME MEASURES: We analyzed survival, perioperative complications, resource utilization metrics (length of stay, discharge disposition, healthcare costs), functional recovery, patient-reported outcomes, reoperation rates, and pain-related measures.
    METHODS: A comprehensive search was conducted across PubMed/Medline, Cochrane Database of Systematic Reviews, and Epistemonikos from inception to May 14, 2025 for studies reporting outcomes by surgical planning status in MSTS. Surgical planning status was defined as planned (elective) versus unplanned (urgent/emergent) procedures. Study quality was assessed using the Methodological index for non-randomized studies (MINORS) tool. Short-term outcomes were defined as events occurring within 30 days postoperatively. The impact of surgical planning status on outcomes was systematically synthesized. Meta-analysis feasibility was assessed based on consistency in operational definitions.
    RESULTS: Out of 1,279 articles, twenty-eight studies comprising 76,291 patients (mean age 62 years, 43% female) met inclusion criteria. The MINORS analysis yielded 79% of studies to be of "moderate" methodological quality. Meta-analysis was not undertaken due to substantial heterogeneity in surgical planning definitions, with timing cutoffs ranging from 4 to 48 hours. Patients undergoing unplanned surgery more frequently presented with non-ambulatory status (41% vs 6%) and neurological compromise, suggesting more advanced disease at presentation. Unplanned surgery was associated with worse short-term outcomes, including reduced survival (67% of reporting studies) and higher complication rates (57% of reporting studies). However, these differences diminished over time, with only 31% of reporting studies demonstrating long-term survival benefits for planned surgery. Patient-reported outcomes converged beyond three months postoperatively. In contrast, resource utilization consistently favored planned surgery, with prolonged hospitalization reported in 88% of reporting studies and increased costs associated with unplanned procedures.
    CONCLUSION: Patients requiring unplanned MSTS have worse short-term outcomes but similar long-term outcomes compared to those undergoing planned surgery, may primarily reflect confounding by baseline disease severity and neurological compromise at presentation rather than detrimental effects of urgent intervention itself. The persistent impact of unplanned surgery lies in increased healthcare resource utilization associated with managing more advanced disease presentations. These findings support improving healthcare system strategies focused on early detection, coordinated referral pathways, and rapid-access spine oncology programs rather than delaying indicated surgery for patient optimization.
    Keywords:  Complications; Metastatic spine disease; Metastatic spine tumor surgery; Rapid-access spine oncology; Resource utilization; Surgical planning status; Survival
    DOI:  https://doi.org/10.1016/j.spinee.2026.09.003
  7. Front Med (Lausanne). 2026 ;13 1895624
    Impact of inflammatory bowel disease on perioperative complications in patients undergoing surgery for metastatic spinal tumors.
    Le Fan, Kenan Sun, Wanshan Shang, Zifeng Wang, Jiayi Guo, Lanbo Yang.
       Background: The global prevalence of inflammatory bowel disease (IBD) continues to rise. However, researchers have not yet investigated how IBD influences perioperative complication rates in patients undergoing surgical intervention for metastatic spinal tumors. This study used the United States National Inpatient Sample (NIS) to evaluate the association between IBD and perioperative complications in patients undergoing surgery for metastatic spinal tumors.
    Methods: Patients undergoing surgical treatment for spine metastases from 2016 to 2022 were identified through ICD-10-CM diagnostic coding, and their data were analyzed. The study population excluded individuals younger than 18 years. Participants were stratified according to whether they had IBD or not, and comparisons were made across demographic characteristics, hospital-related factors, intraoperative parameters, comorbid conditions, and perioperative complications. The statistical methodology encompassed Pearson χ2 analysis, Wilcoxon rank-sum testing, and logistic regression modeling. The perioperative complications were selected based on their clinical relevance, availability within the NIS database, and consistency with previous nationwide database studies evaluating postoperative outcomes following spine surgery.
    Results: Among 48,465 patients with metastatic spinal tumors 535 (1.1%) had concurrent IBD. Patients with IBD exhibited significantly higher odds of developing various perioperative complications. These included wound disruption (aOR = 5.41; P < 0.001), post-procedural hematoma (aOR = 4.57; P = 0.002), post-procedural infection (aOR = 3.83; P < 0.001), gastrointestinal system complications (aOR = 3.36; P < 0.001), and cerebrospinal fluid leakage (aOR = 1.93; P = 0.014).
    Conclusions: Patients with IBD undergoing surgery for metastatic spinal tumors were at significantly increased risk of wound-related complications, post-procedural hematoma, postoperative infection, gastrointestinal complications, and cerebrospinal fluid leakage. These findings support careful preoperative risk stratification and individualized perioperative management in this high-risk population.
    Keywords:  National Inpatient Sample; complications; database; inflammatory bowel disease; spinal column metastases
    DOI:  https://doi.org/10.3389/fmed.2026.1895624
  8. Global Spine J. 2026 Sep 17. 21925682261488401
    Current Trends in Therapeutic Outcomes Among Patients With Metastatic Renal Cell Carcinoma of the Spine: A Systematic Review and Meta-Analysis.
    Tobechukwu C Ndika, Joshua Woo, Brandon T Lee, Eli Johnson, Ezinne Oguguo, Nicole Rivera, Emanuel J Ray, Adedotun Bello, Jessica D'wambe Tiako, Liban Mohamed, Sheng-Fu Larry Lo, Daniel M Sciubba, Rafael De la Garza Ramos, John E O'Toole, Pakawat Chongsathidkiet, Tara Dalton, Kerri-Anne Crowell, Megan Von Isenburg, Trey Mullikin, Melissa Erickson, C Rory Goodwin.
      Study DesignSystematic Review.ObjectivesThe objective of this study was to answer two questions: (1) Did the overall survival (OS) of patients with spinal metastatic renal cell carcinoma (mRCC) improve in publications from 2017 and afterwards compared to 2016 and before? (2) Did the rate of improvement in pain or neurological deficits increase in publications from 2017 and afterwards within this population?MethodsA comprehensive search was conducted to include studies that evaluated either survival or clinical outcomes in the spinal mRCC population from 1986 to 2024.Results63 studies encompassing 1,968 patients were included. The mean age was 59.1 years and 70.85% of patients were male. Pain and neurological deficits were the most common presenting symptoms, seen in 37.5% and 36.0% of patients, respectively. Compared with earlier studies, those published during or after 2017 reported improved median OS across spine surgery (27 vs. 12.3 months), radiotherapy (41.3 vs. 10.8 months), and systemic therapy (29.01 vs. 11.45 months) groups. Meta-analysis of 1-year overall survival for patients undergoing spine surgery showed significant improvement from 2017 afterwards (p<0.05). The neurological improvement rate was significantly higher from 2017 afterwards although pain relief did not differ between publication eras.ConclusionsStudies published from 2017 onward report better survival among spinal mRCC patients than earlier studies. Since the analysis is keyed to publication era rather than the therapy each patient received, the contribution of individual modalities cannot be separated, and the improvement likely reflects advances in surgery, radiotherapy, systemic therapy, and patient selection.
    Keywords:  radiotherapy; renal cell carcinoma; spine surgery; spine tumors; survival; systematic review; systemic therapy
    DOI:  https://doi.org/10.1177/21925682261488401
  9. Clin Genitourin Cancer. 2026 Aug 25. pii: S1558-7673(26)00154-0. [Epub ahead of print] 102654
    Assessment of Bone Metastases, Skeletal-Related Events and Bone-Targeting Agents in Patients With Metastatic Renal Cell Carcinoma Receiving First-Line Systemic Therapy (Meet-URO 33 Study Subanalysis).
    Anna Amela Valsecchi, Sara Elena Rebuzzi, Maria Concetta Cursano, Francesco Pantano, Rossana Berardi, Davide Bimbatti, Lucia Bonomi, Giovanni Bozza, Enrico Bronte, Sebastiano Buti, Claudia Carella, Alessia Cavo, Emilia Cocorocchio, Alberto Dalla Volta, Filippo Maria Deppieri, Andrea Di Marco, Marilena Di Napoli, Martina Fanelli, Emanuela Fantinel, Arianna Dri, Roberto Filippi, Giuseppe Fornarini, Luca Galli, Annalisa Guida, Massimiliano Icardi, Francesca La Russa, Cristian Lolli, Laura Lombardo, Francesca Maines, Brigida Anna Maiorano, Cristina Masini, Carlo Messina, Cecilia Nasso, Cinzia Ortega, Francesco Pierantoni, Giuseppe Procopio, Sarah Scagliarini, Alessio Signori, Mariella Sorarù, Luca Tondulli, Elena Verzoni, Francesca Vignani, Maria Giuseppa Vitale, Silvia Zai, Paolo Andrea Zucali, Ugo De Giorgi, Daniele Santini, Massimo Di Maio.
       INTRODUCTION: Bone metastases (BMs) in patients with metastatic renal cell carcinoma (mRCC) negatively affect survival, quality of life, and increase the risk of skeletal-related events (SREs). Evidence remains limited in the era of first-line immune-based combinations.
    PATIENTS AND METHODS: Meet-URO 33 is an Italian multicenter observational retrospective-prospective study enrolling mRCC patients receiving first-line therapy. The primary endpoint was overall survival (OS). Secondary endpoints included progression-free survival (PFS), clinical characterization, incidence of SREs, and impact of bone-targeting agents (BTAs). Survival was analyzed using the Kaplan-Meier method, log-rank test and Cox proportional hazards model.
    RESULTS: A total of 1696 patients enrolled between 2021 and 2025 were included; 526 (31%) had BMs at metastatic diagnosis. Patients with BMs more frequently had poorer performance status and unfavorable International mRCC Database Consortium (IMDC) risk. The presence of BMs was associated with significantly worse OS (median 26.9 vs. 102.1 months; hazard ratio [HR] 0.53; P < .001) and worse PFS (median 14.2 vs. 19.4 months; HR 0.71; P < .001), with OS and PFS varying according to first-line regimen. Worse OS persisted across IMDC risk classes and treatment types; PFS differences were not significant in favorable/intermediate IMDC risk groups and with tyrosine kinase inhibitor monotherapy. Neither anatomical site nor number of BMs significantly affected OS. SRE incidence in patients with BMs was 26.8%, more frequent with spinal, rib, or other-site involvement, and more common in BTA-treated patients (22.2% vs. 13.7%, P = .03), likely reflecting selection bias.
    CONCLUSION: BMs are confirmed a negative prognostic factor in mRCC involving persistent unmet clinical needs.
    Keywords:  Bone target agents; ICI-ICI; ICI-TKI; Real-world; Renal cancer
    DOI:  https://doi.org/10.1016/j.clgc.2026.102654
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