Article ID: 2026-0282
Introduction: Breast cancer frequently metastasizes to the spine and is associated with more favorable survival than many other solid tumors. However, contemporary comparative data reflecting modern systemic therapies remain limited. Updated survival benchmarks may improve prognostication and patient counseling in metastatic spine disease.
Methods: Adult patients undergoing surgery for spinal metastases were identified in the TriNetX network. Cohorts included breast cancer and five nonbreast primaries (lung, prostate, multiple myeloma [MM], liver, and renal). Propensity score matching (1:1) was performed across 27 demographic and comorbidity variables. Outcomes included postoperative survival at 90 days, 6 months, 1 year, and 5 years, assessed using risk ratios, Kaplan–Meier estimates, and log-rank tests.
Results: At 5 years, breast cancer demonstrated significantly higher survival than lung (48.99% vs. 24.27%; p <0.001; n = 587), prostate (50.07% vs. 34.17%; p <0.001; n = 429), liver (47.67% vs. 5.55%; p <0.001; n = 137), and renal (48.98% vs. 25.34%; p <0.001; n = 426) cancers. MM showed comparable survival through earlier time points and higher 5-year survival than breast cancer (62.40% vs. 49.47%; p = 0.017; n = 377).
Conclusions: Breast cancer spinal metastases are associated with substantially improved survival compared with most other malignancies, with the notable exception of MM. These findings reflect underlying tumor biology and modern systemic therapies and provide updated prognostic context for patient counseling in metastatic spine disease.
