Kaye Brandon, Kehoe Laura, Dholaria Nikhil, Sabahi Mohammadmahdi, Soltani Khaboushan Alireza, T Soto Rubio Diego, Yusuf Fayyadh, Choi Hoon, Cuello César Carballo, Alikhani Puya
Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA.
Department of Neurosurgery, Children's Health Ireland, Temple Street Hospital, Dublin, Ireland.
Eur Spine J. 2025 Aug 20. doi: 10.1007/s00586-025-09158-4.
Spinal metastases affect up to 70% of systemic cancer patients, with overall survival averaging less than six months. Traditional chemotherapeutic agents have unsatisfactory results, leading to immunotherapy (IT) investigations. There is no clear consensus on the benefits and risks of IT for spinal tumors. This study assesses the current literature to determine IT safety and survival efficacy for tumors involving spinal column.
Following PRISMA guidelines, a systematic search was conducted across Embase, Scopus, Web of Science, and PubMed through September 15, 2024. Patient demographics, disease control, survival, and toxicity were analyzed using R. A meta-analysis was conducted using a random-intercept logistic regression model to evaluate the effectiveness of adjunctive IT for spine tumors. The quality of included studies assessed using the Methodological Index for Non-Randomized Studies (MINORS).
A total of 416 articles were screened, with 17 included for qualitative analysis. The studies included 727 patients, with excluding cases of unknown primary origin, the most common primary tumor types were lung cancer, followed by renal cell carcinoma, and melanoma. The most common IT treatments in studies that reported specific types were anti-PD-L1, followed by anti-PD-1 treatments. Meta-analysis showed tumor control rates of 80% (95% CI: 71-87%) following adjunctive IT and the pooled toxicity rate was 5% (95% CI: 1-26%), both with low heterogeneity (I² = 0%). With a maximum follow-up period of 97 months on patients with available data, there were 65 recorded deaths (65.7%) which were all in patients with metastatic spine tumors and no death were recorded in primary spine tumors and the log-rank test indicated a significantly higher overall survival (OS) rate for adjunctive IT in patients with primary spine tumors compared to those with metastatic spine tumors (P< 0.0001). The OS rates were 75%, 57%, 38%, 26%, and 16% at 6-, 12-, 24-, 36-, and 60 months post-IT, respectively.
When used as an adjuvant treatment, IT is associated with a high rate of tumor control and a low rate of toxicity in patients with spinal metastases. Additionally, there is a significant improvement in OS for patients with primary spine tumors compared to those with metastatic spine tumors as an adjuvant treatment. Future studies are warranted to further elucidate the benefits and risks of IT in this patient population as a primary treatment modality.
脊柱转移瘤影响多达70%的全身癌症患者，总体生存期平均不足六个月。传统化疗药物效果不理想，从而引发了免疫疗法（IT）的研究。对于脊柱肿瘤采用IT治疗的益处和风险尚无明确共识。本研究评估当前文献，以确定IT治疗涉及脊柱的肿瘤的安全性和生存疗效。
按照PRISMA指南，截至2024年9月15日，在Embase、Scopus、科学网和PubMed上进行了系统检索。使用R软件分析患者人口统计学、疾病控制、生存情况和毒性。采用随机截距逻辑回归模型进行荟萃分析，以评估辅助IT治疗脊柱肿瘤的有效性。使用非随机研究方法学指数（MINORS）评估纳入研究的质量。
共筛选出416篇文章，17篇纳入定性分析。这些研究包括727例患者，排除原发灶不明的病例后，最常见的原发肿瘤类型为肺癌，其次是肾细胞癌和黑色素瘤。报告了具体类型的研究中，最常见的IT治疗是抗程序性死亡受体配体1（anti-PD-L1），其次是抗程序性死亡蛋白1（anti-PD-1）治疗。荟萃分析显示，辅助IT治疗后的肿瘤控制率为80%（95%置信区间：71%-87%），合并毒性率为5%（95%置信区间：1%-26%），两者异质性均较低（I² = 0%）。对有可用数据的患者进行的最长随访期为97个月，记录到65例死亡（65.7%），均为脊柱转移瘤患者，原发脊柱肿瘤患者无死亡记录，对数秩检验表明，与脊柱转移瘤患者相比，辅助IT治疗的原发脊柱肿瘤患者的总生存期（OS）率显著更高（P<0.0001）。IT治疗后6个月、12个月、24个月、36个月和60个月时的OS率分别为75%、57%、38%、26%和16%。
作为辅助治疗时，IT治疗脊柱转移瘤患者的肿瘤控制率高且毒性率低。此外，与作为辅助治疗的脊柱转移瘤患者相比，原发脊柱肿瘤患者的OS有显著改善。有必要开展进一步研究，以进一步阐明IT作为主要治疗方式在该患者群体中的益处和风险。
