Current Trends in Therapeutic Outcomes Among Patients With Metastatic Renal Cell Carcinoma of the Spine: A Systematic Review and Meta-Analysis.

Abstract

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.