Journal of Bone Oncology最新文献

{"title":"Risk factors and clinical impact of bone pain in patients with multiple myeloma – A prospective interdisciplinary study","authors":"Carlotta Pietsch,&nbsp;Monika Engelhardt,&nbsp;Julian P. Maier,&nbsp;Gabriele Ihorst,&nbsp;Hagen Schmal,&nbsp;Evangelos Terpos,&nbsp;Ioannis Ntanasis-Stathopoulos,&nbsp;Ralph Wäsch,&nbsp;Georg W. Herget","doi":"10.1016/j.jbo.2026.100788","DOIUrl":"10.1016/j.jbo.2026.100788","url":null,"abstract":"<div><h3>Background</h3><div>Bone pain affects up to 80% of patients with multiple myeloma (MM) patients and significantly impairs quality of life (QoL), yet its specific predictors remain poorly characterized. Identifying risk factors is essential for early intervention and personalized treatment.</div></div><div><h3>Methods</h3><div>This prospective, single-center study included 352 patients. Bone pain was recorded using a standardized questionnaire. Multivariate logistic regression with stepwise selection was used to identify independent predictors of bone pain. QoL and health-related status were assessed on a 7-point scale and compared using the Wilcoxon two-sample test.</div></div><div><h3>Results</h3><div>Bone pain was reported by 184 patients (52%). Independent predictors of bone pain were osteolytic lesions with fracture risk (OR 3.06, 95% CI 1.46–6.40, <em>p</em> = 0.003) and pre-existing orthopedic disease (OR 2.78, 95% CI 1.77–4.36; <em>p</em> &lt; 0.0001). CRAB (hypercalcemia, renal failure, anemia, bone lesions)-B at initial diagnosis (OR 1.74, 95% CI 0.92–3.29, <em>p</em> = 0.09) and progressive disease (OR 1.68, 95% CI 0.93–3.05, p = 0.09) showed an elevated risk for bone pain. No associations were observed for age, sex, CRAB-C/-R/-A, International Staging System (ISS) stage, and disease duration after adjustment. Patients with bone pain had significantly lower median QoL and health-related status compared to patients without pain (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Osteolytic lesions with fracture risk and pre-existing orthopedic conditions independently predict bone pain in patients with MM. These findings highlight the different etiology and the overlap between orthopedic and oncological conditions. Interdisciplinary management is essential to distinguish MM-caused pain from degenerative pain and optimize individualized care.</div></div>","PeriodicalId":48806,"journal":{"name":"Journal of Bone Oncology","volume":"59 ","pages":"Article 100788"},"PeriodicalIF":3.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13424186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148654751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrative machine learning and multi-omics identify a centromere gene signature and validate B3GALT4 as a tumor suppressor in osteosarcoma","authors":"Wenchao Yao,&nbsp;LinPing Zhang,&nbsp;Zhen Jiang,&nbsp;Tao Bao,&nbsp;Junhua Ma,&nbsp;Jiangbo Nie","doi":"10.1016/j.jbo.2026.100787","DOIUrl":"10.1016/j.jbo.2026.100787","url":null,"abstract":"<div><h3>Background</h3><div>Centromere-associated genes are linked to genomic instability and tumor progression, yet their significance and immunological roles in osteosarcoma (OS) remain undefined.</div><div><strong>Methods:</strong></div><div>We developed a centromere-associated prognostic gene model (CPGM) by applying machine learning across independent cohorts, including TARGET-OS and GEO databases. The Meta-OS and GEO datasets were integrated to form a comprehensive Meta-OS cohort for further analysis. Model performance was evaluated using Harrell's concordance index (C-index). Then, the optimal model was selected and validated using Kaplan-Meier plotter, time-dependent ROC (tROC), Cox regression, and nomogram construction. Functional enrichment and immune infiltration analyses were performed to characterize the tumor immune microenvironment. Single-cell RNA sequencing (scRNA-seq) was conducted to assess cellular heterogeneity and intercellular communication. Finally, the function of Beta-1,3-galactosyltransferase 4 (B3GALT4) was validated using in vitro assays to evaluate its effects on OS cell proliferation and migration.</div><div><strong>Results:</strong></div><div>The CPGM demonstrated consistent prognostic performance across independent datasets, achieving a maximum C-index at 0.733. The tROC analysis showed strong predictive accuracy, with area under of curve values of 0.857, 0.806, and 0.783 at 1, 3, and 5 years, respectively. Univariate and multivariate Cox analyses confirmed CPGM as an independent prognostic factor (<em>p</em> = 0.002). Meanwhile, high CPGM scores were associated with poor survival, higher tumor purity, reduced immune infiltration, and suppressed antitumor immune responses. Enrichment analyses indicated significant involvement of immune-related pathways. scRNA-seq analysis revealed that high-CPGM cells were enriched in early developmental trajectories and exhibited enhanced intercellular signaling. Among the model genes, B3GALT4 was consistently downregulated in OS tissues and cell lines, and low expression correlated with poor prognosis. Overexpression of B3GALT4 significantly inhibited the proliferation, migration and invasion of OS cells.</div><div><strong>Conclusion:</strong></div><div>This study establishes a robust centromere-associated prognostic model linked to immune dysregulation in OS and identifies B3GALT4 as a potential tumor suppressor and therapeutic target.</div></div>","PeriodicalId":48806,"journal":{"name":"Journal of Bone Oncology","volume":"59 ","pages":"Article 100787"},"PeriodicalIF":3.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13393646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148580832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recombinant LGR4 extracellular domain attenuates osteoclastogenesis and prevents bone metastasis via RANKL inhibition","authors":"Meng Fu,&nbsp;Guowei Chang,&nbsp;Shuilin Shao,&nbsp;Liying Zhao","doi":"10.1016/j.jbo.2026.100768","DOIUrl":"10.1016/j.jbo.2026.100768","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Bone metastasis is a severe complication of advanced cancers, disrupting bone remodeling by hijacking the RANK/RANKL/OPG axis, which leads to excessive osteoclast activation and bone resorption. Current therapies, such as bisphosphonates and denosumab, offer limited survival benefits and carry significant safety risks, highlighting the need for novel agents that effectively inhibit osteolytic progression.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;This study aimed to evaluate the therapeutic potential of a recombinant extracellular domain of leucine-rich repeat-containing G-protein coupled receptor 4 (rLGR4-ECD), produced in CHO cells, to inhibit RANKL signaling, suppress osteoclastogenesis, and prevent bone metastasis in preclinical models.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The human LGR4-ECD (residues 25–540) was cloned into the pcDNA4/TO vector and expressed in CHO-K1 cells. Stable monoclonal lines were established, and recombinant protein was purified via Ni-NTA affinity chromatography. Binding affinity to RANKL and RSPO4 was assessed by co-immunoprecipitation (co-IP). &lt;em&gt;In vitro&lt;/em&gt;, bone marrow-derived monocytes were treated with RANKL and varying concentrations of rLGR4-ECD (0–80 ng/mL), and osteoclast formation was evaluated by TRAP staining, qPCR, and Western blotting for osteoclast markers. For &lt;em&gt;in vivo&lt;/em&gt; evaluation, a breast cancer bone metastasis model was established by intracardiac injection of 4 T1-Luc cells into BALB/c mice. Mice were treated daily with 1 mg/kg rLGR4-ECD or PBS via tail vein injection. Metastatic burden was monitored by bioluminescence imaging, osteoclast activity by TRAP staining of calvaria, and gene expression in bone tissue by qPCR. Survival was analyzed using Kaplan-Meier curves.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;rLGR4-ECD was successfully expressed and purified with over 95% purity and a yield of 2.38 mg/L. It bound specifically to RANKL and RSPO4 in co-IP assays. &lt;em&gt;In vitro&lt;/em&gt;, rLGR4-ECD dose-dependently inhibited osteoclast formation, with near-complete suppression at 80 ng/mL (IC50 = 42.38 ng/mL). Expression of osteoclast genes &lt;em&gt;Acp5&lt;/em&gt;, &lt;em&gt;Ctsk&lt;/em&gt;, and &lt;em&gt;Nfatc1&lt;/em&gt; was reduced by 91.4% (&lt;em&gt;***p &lt; 0.001&lt;/em&gt;), 87.1% (&lt;em&gt;***p &lt; 0.001&lt;/em&gt;), and 81.2% (&lt;em&gt;***p &lt; 0.001&lt;/em&gt;), respectively, at 80 ng/mL. Protein levels of TRAP, Cathepsin K, and NFATc1 were also significantly suppressed. &lt;em&gt;In vivo&lt;/em&gt;, rLGR4-ECD treatment reduced metastatic burden by 67.3% (&lt;em&gt;***p &lt; 0.001&lt;/em&gt;) and decreased osteoclast surface per bone surface by 56.2% (&lt;em&gt;***p &lt; 0.001&lt;/em&gt;). Gene expression in bone tissue showed reductions of 71.3% for &lt;em&gt;Acp5&lt;/em&gt; (&lt;em&gt;***p &lt; 0.001&lt;/em&gt;), 40.1% for &lt;em&gt;Ctsk&lt;/em&gt; (&lt;em&gt;***p &lt; 0.001&lt;/em&gt;), and 86.5% for &lt;em&gt;Nfatc1&lt;/em&gt; (&lt;em&gt;***p &lt; 0.001&lt;/em&gt;). rLGR4-ECD median survival by 41.7% (12 vs. 17 days) without affecting lung metastasis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;rLGR4-ECD effectively inhibits RANKL-ind","PeriodicalId":48806,"journal":{"name":"Journal of Bone Oncology","volume":"58 ","pages":"Article 100768"},"PeriodicalIF":3.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148167798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opinion statement regarding the use of post-operative radiotherapy after surgery for pathological fractures of the long bones: An answer to the points raised regarding methodology and analysis","authors":"Jessica Ehne,&nbsp;Panagiotis Tsagkozis","doi":"10.1016/j.jbo.2026.100758","DOIUrl":"10.1016/j.jbo.2026.100758","url":null,"abstract":"","PeriodicalId":48806,"journal":{"name":"Journal of Bone Oncology","volume":"58 ","pages":"Article 100758"},"PeriodicalIF":3.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148231241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tenosynovial giant cell tumor of the hip: a systematic review and institutional case series with Meta-analysis of recurrence and patient-reported outcomes","authors":"E. van der Loos ,&nbsp;D.T. Meijer ,&nbsp;J.A.M. Bramer ,&nbsp;H.W.B. Schreuder ,&nbsp;F.G.M. Verspoor","doi":"10.1016/j.jbo.2026.100769","DOIUrl":"10.1016/j.jbo.2026.100769","url":null,"abstract":"<div><h3>Background</h3><div>Tenosynovial giant cell tumors (TGCT) are rare, locally aggressive neoplasms of the synovium, most frequently affecting the knee and less commonly the hip. Due to its deep anatomy and weight-bearing function, hip TGCT may follow a distinct clinical course. This study evaluates clinical presentation, treatment outcomes, recurrence patterns, and patient-reported outcomes in hip TGCT.</div></div><div><h3>Methods</h3><div>A systematic literature search in PubMed, Embase, and Cochrane Library (January 2000–May 2025) identified studies including ≥5 patients with hip TGCT reporting recurrence, complications, functional outcomes or patient-reported outcomes. A random-effects meta-analysis assessed recurrence risk across treatment modalities. Additionally, 23 patients of two retrospective institutional cohorts were analyzed, including PROMIS-CAT assessment.</div></div><div><h3>Results</h3><div>Seventeen studies comprising 269 patients were included. The mean age was 32 years and 58% were female. At diagnosis, 48% of patients with available cartilage data demonstrated advanced degeneration (grade ≥ 3). No statistically significant differences in recurrence risk were observed between treatment strategies; arthroscopic synovectomy, open synovectomy, and total hip arthroplasty. However, comparisons were limited by heterogeneous patient selection and follow-up duration. Arthroplasty was associated with the highest complication rate (33%), primarily aseptic loosening (19%). In the institutional cohort, 21.7% experienced recurrence and 29.4% required conversion to THA. Recurrences and conversions occurred exclusively in D-TGCT. PROMIS-CAT pain interference scores remained elevated (mean T-score 63.4 ± 11.1).</div></div><div><h3>Conclusion</h3><div>Hip TGCT shows substantial cartilage damage at diagnosis and persistent postoperative morbidity. While recurrence rates appear comparable between surgical strategies, arthroplasty carries a higher complication burden in this predominantly young population. Prospective multicenter studies with standardized outcome reporting are required to optimize treatment strategies.</div></div>","PeriodicalId":48806,"journal":{"name":"Journal of Bone Oncology","volume":"58 ","pages":"Article 100769"},"PeriodicalIF":3.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148167797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor regarding “Questionable indication for postoperative radiotherapy after surgery for metastases of the major long bones”: A cautionary note on methodology and analysis","authors":"Shing Fung Lee ,&nbsp;Joel A. Finkelstein ,&nbsp;Peter J. Hoskin ,&nbsp;Dirk Rades ,&nbsp;Eva Oldenburger ,&nbsp;Tracy A. Balboni ,&nbsp;Daniel E. Roos ,&nbsp;Hans Kreder ,&nbsp;Eric L. Chang ,&nbsp;Samuel Ryu ,&nbsp;Amal Khoury ,&nbsp;Kristopher Dennis ,&nbsp;Candice Johnstone ,&nbsp;Sara R. Alcorn ,&nbsp;Charles B. Simone II ,&nbsp;Stephanie Brown ,&nbsp;Jonas Willmann ,&nbsp;Joanne M. van der Velden ,&nbsp;Mateusz Spałek ,&nbsp;Yvette M. van der Linden ,&nbsp;Henry C.Y. Wong","doi":"10.1016/j.jbo.2026.100757","DOIUrl":"10.1016/j.jbo.2026.100757","url":null,"abstract":"","PeriodicalId":48806,"journal":{"name":"Journal of Bone Oncology","volume":"58 ","pages":"Article 100757"},"PeriodicalIF":3.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148231242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efferocytosis-associated transcriptomic patterns characterize prognosis and immune landscape in osteosarcoma","authors":"Xueliang Song ,&nbsp;Xiaofan Tou ,&nbsp;Li Li ,&nbsp;Fengxian Wang ,&nbsp;Chengqun Qian ,&nbsp;Ru Wang ,&nbsp;Jiahong Shen","doi":"10.1016/j.jbo.2026.100743","DOIUrl":"10.1016/j.jbo.2026.100743","url":null,"abstract":"<div><h3>Background</h3><div>Osteosarcoma (OS) is the most common primary malignant bone tumor in adolescents, characterized by high heterogeneity and poor prognosis. Efferocytosis, the clearance of apoptotic cells, has been implicated in tumor progression and immune evasion, but its role in OS remains unclear.</div></div><div><h3>Methods</h3><div>We integrated TARGET-OS as a training cohort with three GEO datasets for validation. Efferocytosis pathways were quantified by ssGSEA, and WGCNA was applied to identify associated gene modules. Candidate genes were screened using univariate Cox regression, and a prognostic signature was developed with machine learning models and validated across cohorts. Functional enrichment, immune infiltration, and immunotherapy prediction analyses were performed. scRNA-seq from six OS patients and spatial transcriptomic profiling were further used to characterize the cellular distribution and communication of efferocytosis-related genes. The functions of MAGEA11 in OS were explored both in vivo and in vitro.</div></div><div><h3>Results</h3><div>The Brown module showed the strongest association with efferocytosis pathways. The StepCox + Ridge model achieved robust prognostic performance and stratified patients into risk groups with significantly different survival. Enrichment analysis revealed upregulated genes related to endothelial and nitric oxide pathways, while downregulated genes were linked to immune signaling and extracellular matrix remodeling. High-risk patients exhibited elevated M2 macrophages, altered checkpoint expression, and greater predicted sensitivity to immunotherapy. At the single-cell level, efferocytosis activity was enriched in OS cells, with MAGEA11 showing the highest expression. High-risk tumors displayed stronger intercellular signaling, particularly from OS cells and CAFs to macrophages and endothelial cells. Spatial transcriptomics confirmed enrichment of efferocytosis at tumor and interface regions, correlating positively with stromal and myeloid cells and negatively with T cells. Mechanistically, MAGEA11 promoted OS tumor growth, and drove a pro-efferocytic microenvironment by enhancing Gas6 secretion, which polarized macrophages toward an M2 phenotype and upregulated their efferocytosis receptors (MERTK/AXL).</div></div><div><h3>Conclusions</h3><div>We established an efferocytosis-related prognostic signature and elucidated its underlying mechanism wherein MAGEA11 promoted immunosuppression via a Gas6-MERTK/AXL-dependent efferocytosis circuit. This integrated study positions efferocytosis as a key driver of the OS microenvironment and a promising target for clinical intervention.</div></div>","PeriodicalId":48806,"journal":{"name":"Journal of Bone Oncology","volume":"57 ","pages":"Article 100743"},"PeriodicalIF":3.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146025341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Questionable indication for postoperative radiotherapy after surgery for metastases of the major long bones: A single-centre cohort study of 552 fractures/526 patients","authors":"Jessica Ehne ,&nbsp;Adele Kastensson ,&nbsp;Rikard Wedin ,&nbsp;Panagiotis Tsagkozis","doi":"10.1016/j.jbo.2026.100746","DOIUrl":"10.1016/j.jbo.2026.100746","url":null,"abstract":"<div><h3>Introduction</h3><div>The use of postoperative radiotherapy (PORT) as an adjunct to orthopaedic surgery of the long bones is widely recommended. Evidence of the benefits is however sparse. The primary research question of this study was whether PORT reduces the incidence of local failure after orthopaedic surgery for metastatic disease of the long bones.</div></div><div><h3>Method</h3><div>A prospectively collected database was retrospectively reviewed. A total of 552 fractures/526 patients were included. Primary endpoint was secondary surgery due to implant failure due to local tumour progression. The main analysis used a competing risk model with death as a competing event.</div></div><div><h3>Results</h3><div>PORT was administered in 197 cases, the median initiation time was 42 days and the most common schedule was 4 Gy × 5. 33 cases (6%) required revision attributed to tumour related implant failure. The cumulative incidence of failure was higher in the PORT group (p = 0.038). When dividing cases into subgroups depending on surgical method PORT had no effect in the osteosynthesis group and was significantly associated with a worse outcome in the prosthesis group. PORT dose and timing were not associated with failure rates.</div></div><div><h3>Conclusion</h3><div>In this cohort, PORT was associated with a significantly increased risk of tumour related failure in patients treated with a prosthesis. There was no significant effect in the osteosynthesis subgroup. Our results indicate that there is no clear evidence for the universal use of PORT.</div></div>","PeriodicalId":48806,"journal":{"name":"Journal of Bone Oncology","volume":"57 ","pages":"Article 100746"},"PeriodicalIF":3.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146174051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective external validation of a three-predictor frailty model for 90-day survival and complications following spinal metastasis surgery","authors":"Pedro Reggiani Anzuategui ,&nbsp;Glauco José Pauka Mello ,&nbsp;Ana Valéria Brunetti Rigolino ,&nbsp;Lucas Emanuel Sauer Larocca ,&nbsp;Cássio Zini ,&nbsp;Carmen Australia Paredes Marcondes Ribas","doi":"10.1016/j.jbo.2026.100739","DOIUrl":"10.1016/j.jbo.2026.100739","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background context&lt;/h3&gt;&lt;div&gt;Surgical decision-making in patients with spinal metastases remains complex due to the need to balance potential surgical benefits with limited survival and common frailty. Predictive models can assist in this process, but their clinical utility is often limited by complexity and lack of validation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;To externally validate a simple three-predictor frailty model for 90-day survival and complications, and to compare its performance with other commonly used tools.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study design/setting&lt;/h3&gt;&lt;div&gt;Prospective external validation study conducted at a single tertiary cancer center.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patient sample&lt;/h3&gt;&lt;div&gt;A consecutive cohort of 126 patients who underwent open posterior surgery with instrumentation for spinal metastases from solid tumors between 2018 and 2024.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome measures&lt;/h3&gt;&lt;div&gt;Primary outcomes were 90-day survival and the occurrence of postoperative complications. Secondary outcomes included 30-day, 180-day and overall survival. Model performance was evaluated through discrimination (AUC), risk stratification, accuracy for surgical indication and calibration.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The Anzuategui model (three predictors: tumor growth rate, comorbidities, and lymphocyte count) was applied preoperatively, along with four other three-predictor models (Tomita, Modified Bauer, Van der Linden, and Sioutos). Discrimination was assessed using ROC curves. Risk stratification was evaluated using predefined low-, moderate-, and high-risk categories, analyzed through Kaplan–Meier curves and complication rates. Model accuracy for surgical indication was calculated using a 90-day survival threshold as the reference. Calibration for both 90-day survival and postoperative complications was performed by comparing category-specific predicted probabilities derived from the development cohort with observed event rates in the validation cohort.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The Anzuategui model demonstrated predictive performance for the primary outcomes comparable to the other models under evaluation. It achieved an AUC of 0.78 (95% CI: 0.70–0.85) for 90-day survival and 0.68 (95% CI: 0.59–0.76) for postoperative complications. Risk stratification showed clear separation between survival curves across the three predefined categories. Accuracy for predicting appropriate surgical indication was 70% (95% CI: 61–78), with a sensitivity of 64% and specificity of 85%. Tomita and Modified Bauer models showed comparable accuracy (75% and 74%, respectively) but lower specificity. Calibration indicated overestimation of 90-day mortality (intercept –1.75; slope 2.05) and modest miscalibration for postoperative complications (intercept –0.40; slope 0.67).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The Anzuategui model demonstrated acceptable external performance, with greater validity for predicting 90-day survival than for post","PeriodicalId":48806,"journal":{"name":"Journal of Bone Oncology","volume":"57 ","pages":"Article 100739"},"PeriodicalIF":3.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145982069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and oncologic outcome of en resection with intentional tumor transgression in primary spinal sarcoma: The Korean Society of Spinal Tumors multicenter study (KSST 2024–02)","authors":"Bong-Soon Chang ,&nbsp;Se-Jun Park ,&nbsp;Dong-Ho Kang ,&nbsp;Jae Hwan Cho ,&nbsp;Sehan Park ,&nbsp;Sang-Il Kim ,&nbsp;Young-Hoon Kim ,&nbsp;Sang-Min Park ,&nbsp;Sung-Kyu Kim ,&nbsp;Chang-Bae Kong ,&nbsp;Hyoungmin Kim ,&nbsp;Sam Yeol Chang","doi":"10.1016/j.jbo.2026.100747","DOIUrl":"10.1016/j.jbo.2026.100747","url":null,"abstract":"<div><h3>Introduction</h3><div>Primary spinal sarcoma is rare and technically challenging, particularly when attempting en bloc resection with negative margins. Intentional tumor transgression may be used when Enneking-appropriate en bloc resection is not feasible, but its oncologic implications remain unclear. This study evaluated the feasibility and outcomes of en bloc resection with intentional tumor transgression compared with other resection strategies.</div></div><div><h3>Methods</h3><div>This multicenter retrospective study included patients who underwent surgery for primary spinal sarcoma across five tertiary hospitals from 2000 to 2022. Patients were grouped by resection method: (A) en bloc resection with negative margins, (B) en bloc resection with intentional tumor transgression, (C) piecemeal resection, and (D) subtotal resection. Tumor extent was assessed using a modified Weinstein-Boriani-Biagini classification. The primary outcome was overall survival; secondary outcomes included local recurrence, distant metastasis, and perioperative complications.</div></div><div><h3>Results</h3><div>The study included 119 patients (mean age 46.0 ± 19.8 years). Oncological outcomes (overall survival, local recurrence, and distant metastasis) demonstrated significant trends in survival analysis across groups A to D. Although Group B had more extensive disease (&gt;3 quadrants, canal encroachment, multi-level involvement), its overall survival, local recurrence, and distant metastasis did not differ significantly from Group A (hazard ratio [HR] 0.54, p = 0.467; HR 0.46, p = 0.307; HR 0.46, p = 0.237, respectively). Complication rates were comparable between groups A and B.</div></div><div><h3>Conclusion</h3><div>En bloc resection with intentional tumor transgression offers oncologic outcomes comparable to margin-negative en bloc resection in selected patients with more extensive tumors. This technique may be a viable alternative when Enneking-appropriate en bloc resection is not feasible.</div></div>","PeriodicalId":48806,"journal":{"name":"Journal of Bone Oncology","volume":"57 ","pages":"Article 100747"},"PeriodicalIF":3.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146174093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}