ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
Exploring clinical and demographic determinants of time to treatment in spinal metastases: A Large-Scale cohort study of more than 1000 patients.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo identify predictors for time to first treatment modality (TTT) in patients diagnosed with spinal metastatic disease.
methodsOur radiology database was retrospectively queried to identify patients with spinal metastases (01/2017-12/2021). Demographics, setting of initial imaging (inpatient/outpatient/ED), histology, treatment modality, and TTT were collected. Several different early TTT thresholds were explored (≤ 30, ≤ 21, ≤14, and ≤ 7 days). After controlling for age, gender, diagnostic setting, pathology, type of treatment multivariable linear and logistic regressions were performed for the primary and secondary thresholds at different time-points.
resultsA total of 1009 patients with spinal metastases were included, with a median age of 65 years (IQR 15) and 529 (52.4%) males. Diagnoses occurred in the inpatient (37%), outpatient (50%), and emergency department (13%) settings. The most common primary tumors were breast (22.4%), prostate (19.5%), and non-small cell lung cancer (12.8%). Treatment modalities included surgery (14.6%), chemotherapy (54.5%), and radiation therapy (43.5%). The median time to treatment (TTT) was 13 days (SD 27, range 0-676), with no significant difference by setting (p = 0.2). In multivariable linear regression, surgery was associated with shorter TTT (p = 0.037). Logistic regression using different early-TTT thresholds identified age, surgical intervention, lymphoma, and outpatient setting as significant predictors across models. Sensitivity analyses excluding TTT outliers showed that surgery was no longer a significant predictor, while other covariates remained stable.
conclusionsSurgical intervention and lymphoma independently predicted earlier TTT of any modality in spinal metastases, whereas older age and outpatient diagnosis were associated with delays.
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