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Current prognostic models often overlook subtype-specific differences, potentially leading to suboptimal treatment decisions. This study aimed to establish the first comprehensive subtype-specific survival benchmarks for spinal metastases and to evaluate temporal trends in survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a systematic review and meta-analysis of survival outcomes following a predefined protocol (PROSPERO CRD42024580279). Eligible studies reported overall survival (OS) in patients with breast cancer spinal metastases, stratified by immunohistochemistry-based subtype: hormone receptor (HR\u2009+), human epidermal growth factor receptor 2-enriched (HER2\u2009+), and triple-negative breast cancer (TNBC). Survival data were extracted from published figures with a digitizer program and then processed in R. The median OS was analyzed through pooled survival curves with 95% confidence intervals, compared via log-rank tests. To evaluate temporal trends, we performed era-stratified analyses (pre-2000, 2000\u20132019, post-2020) using chronological partitioning of study enrollment periods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After screening 2,348 records, we identified seven eligible cohorts comprising 672 patients. Analysis revealed significant survival differences among subtypes (log-rank\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001), with median OS of 28.9\u00a0months (95% CI 26.0\u201335.6;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009347) for HR\u2009+\u2009, 43.7\u00a0months (31.9\u201348.7;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009244) for HER2\u2009+\u2009, and 10.7\u00a0months (8.9\u201319.2;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200981) for TNBC (very low certainty of evidence for all outcomes). Temporal analysis of 4464 patients from 61 studies demonstrated significant survival improvements post-2020 (log-rank\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study establishes the first real-world unadjusted survival reference for subtypes in breast cancer spinal metastases, suggesting a potential survival advantage of HER2\u2009+\u2009\/HR\u2009+\u2009over HER2\u2009+\u2009\/HR\u2009\u2212\u2009tumors. These findings underscore the essential role of subtyping in refining prognostic assessment for spinal metastases. Our findings demonstrate a temporal improvement in survival and highlight the persistent need for contemporary data in this rapidly evolving clinical landscape.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>PROSPERO CRD42024580279.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12916-026-04715-0","type":"journal-article","created":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T08:35:39Z","timestamp":1771662939000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The influence of immunohistochemistry-based subtypes on overall survival in breast cancer spine metastases: a systematic review and meta-analysis"],"prefix":"10.1186","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5797-1885","authenticated-orcid":false,"given":"Fon-Yih","family":"Tsuang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0309-633X","authenticated-orcid":false,"given":"Yun-Heng","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1872-8133","authenticated-orcid":false,"given":"Ting-Li","family":"Shen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6557-211X","authenticated-orcid":false,"given":"Chiun-Sheng","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7775-4052","authenticated-orcid":false,"given":"Chung Liang","family":"Chai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,2,21]]},"reference":[{"key":"4715_CR1","doi-asserted-by":"publisher","unstructured":"Orrantia-Borunda E, Anchondo-Nu\u00f1ez P, Acu\u00f1a-Aguilar LE, G\u00f3mez-Valles FO, Ram\u00edrez-Valdespino CA. 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