Factors Influencing Survival and Prognosis in Patients with Spinal Metastases from Breast Cancer

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Methods We retrospectively analyzed the clinical data and survival status of 68 BC patients with spinal metastases. All patients with spinal metastases underwent surgical treatment. We identified a range of factors that may affect the survival and prognosis. Kaplan-Meier method was used to perform univariate analysis of the factors that might affect spinal metastases free survival (SMFS) and survival after spinal metastases (OS) respectively. Cox proportional hazards model was established to extract independent prognostic factors for SMFS and OS. Results The mean time of SMFS was 13.83 months (median 6, range 0–66 months). The mean OS was 14.74 months (median,10.5 months; range, 1–64 months). ALP > 91, BC LMR > 4.9, AJCC BC Stage >IIIB, were independent prognostic factors for SMFS. Pre-op Ca125 > 115.2, Tomita Score > 7, Spinal metastases with visceral metastasis, Multiple spinal metastases, and Strategy of spinal surgery were independent prognostic factors for OS. Conclusions ALP > 91, BC LMR > 4.9 and AJCC BC Stage >IIIB can significantly affect SMFS of BC patients. Pre-op Ca125 > 115.2, Tomita Score > 7, Spinal metastases with visceral metastasis, Multiple spinal metastases, and Strategy of spinal surgery can significantly affect OS of BC patients after spinal metastases. Breast Cancer spinal metastases spinal surgery prognostic factors survival analysis Figures Figure 1 Figure 2 1. Introduction According to the 2020 Global Cancer Statistics Report, breast cancer (BC) is the most common malignancy. It is estimated that there were about 2.3 million new cases of breast cancer that year, accounting for 11.7% of all new cancer cases. At the same time, breast cancer is the fifth leading cause of cancer-related deaths worldwide, accounting for 6.9% of all deaths [ 1 ]. The reduction in BC mortality may be related to the relatively mild biology of BC and the continuous optimization of chemoradiotherapy, targeted drugs, and hormone therapy strategies in recent years. At the same time, the incidence of metastatic BC has also increased [ 2 ]. It is estimated that 20%-30% of BCs will metastasize. Bone metastases account for approximately 60–70% of all metastatic BCs [ 3 ]. Due to the large number of spinal segments, abundant blood supply and slow blood flow, the spine is the most common site of breast bone metastasis [ 4 ]. Bone metastases can lead to skeletal-related events (SREs). Hypercalcemia, pathological fractures, spinal cord compression, and painful pathological fractures are the main complications of bone metastases [ 5 ]. These complications seriously affect the patient's neurological function, quality of life, and survival. The treatment of BC spinal metastases requires multidisciplinary cooperation, which can be roughly divided into two categories: systemic treatment and local treatment. Systemic therapy includes analgesic drug therapy, endocrine therapy, chemotherapy, bisphosphonates, immunotherapy and targeted therapy. Local treatment includes radiation therapy and surgery. In previous treatments, patients have a limited life expectancy when metastases indicate that the malignancy patient's disease has entered the terminal stage. Therefore, the length of life expectancy directly affects the choice of treatment strategy [ 5 ]. However, with the development of treatment methods, the life expectancy of cancer patients has increased significantly in recent years. The choice of treatment modality depends not only on the patient's survival but also on the sensitivity of the tumor to chemoradiotherapy and the expected effect of surgical treatment [ 6 ]. Recently, several studies have reported the prognosis factors of patients with BC and give some recommendations for treatment opinions. However, only a limited number of previous studies have especially focused on spinal metastases of BC. The aim of this study is to analyze the clinical data of BC patients with spinal metastases who underwent surgical treatment in our hospital, and to explore the potential prognostic factors of BC patients with spinal metastases. 2. Patients and Methods This research was examined and approved by the Ethics Committee of our hospital (Approval No. HDFYLL-IIT-2025-141). All clinical investigations were conducted according to the principles expressed in the Declaration of Helsinki.The authors did not use generative AI or AI-assisted technologies in the development of this manuscript. 2.1 Patients From January 2016 to December 2024, a total of 479 patients were diagnosed with BC in our hospital, including 182 patients with metastatic BC. Of these 182 patients, 114 patients developed spinal metastases, and 66 of these patients underwent spinal surgery. We performed a detailed review and analysis of these 66 patient's medical records, images, and pathology reports. All patients were followed up every 3 months for the first 6 months after surgery, then every 6 months for the next 2 years, and annually thereafter. All patients were all followed up until December 2024 or until death. The final statuses (died of disease/alive with disease) were acquired through telephone interviews. 2.2 Treatment All patients underwent lumpectomy plus regional lymphadenectomy at the time of initial diagnosis of BC and received corresponding systemic treatment according to the pathological results. After spinal metastases were detected, all patients received surgical interventions including total en-bloc spondylectomy (TES) or separation surgery. Surgery indications are as follows: (1) Pathological fractures and neurological dysfunction due to spinal metastases (2) The estimated preoperative life expectancy is greater than 3 months. Personalized surgical strategies were determined according to Tomita, revised Tokuhashi, and Spinal Instability Neoplastic Score (SINS). All patients received subsequent chemotherapy, radiotherapy, endocrine/targeted therapy and/or bisphosphonate therapy according to the advice of the attending oncologists 1 month after spinal surgery. 2.3 Statistical analysis A series of clinical factors were analyzed to identify independent variables that could affect prognosis. Potential factors include: (1) age, (2) age of BC (3)menstrual status at the initial diagnosis of BC, (4) metabolic syndrome, (5) laboratory tests including CEA, CA125, CA153, alkaline phosphatase(ALP), albumin-to-globulin ratio (AGR), lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio(NLR); platelet-to-lymphocyte ratio(PLR); hemoglobin and albumin levels and lymphocyte and platelet counts(HALP) in the diagnosis of BC within one week before breast surgery and spinal surgery, (6) BC AJCC TNM stage (7) pathological results, including ER, PR, Her-2 and Ki-67, (8) BC/spinal metastases diagnosed with visceral metastasis, (9) spinal metastases segments, (10) SINS Score, Tomita Score, Tokuhashi Score, Frankel score, pre-operative KPS score, (11) strategy of spinal surgery(TES surgery/separation surgery). The optimal cut-off values of age, ALP, NLR, PLR, AGR, LMR, HALP, CEA, Ca125, Ca153, AJCC BC Stage, SINS Score, Tomita Score and Tokuhashi Score were determined by X-tile 3.6.1 software 20 (Yale University, New Haven, CT, USA). Spinal metastases free survival (SMFS) was defined as the date from RCC diagnosis to Spinal metastases. Overall survival (OS) was measured as the date from Spinal metastases to cancer-related death or December 2024. Univariate survival analyses for potential prognostic factors associated with OS and SMFS were conducted using the Kaplan–Meier approach. Variables with p < 0.1 in univariate testing were subsequently entered into a multivariate Cox proportional hazards regression model to determine independent prognostic indicators for OS and SMFS. A two‑sided p < 0.05 was defined as statistically significant. All statistical procedures were performed using IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp., Armonk, NY, USA) 3. Results 3.1. Demographics and Clinical Characteristics The demographic characteristics and clinical characteristics of the 66 BC patients with Spinal metastases were shown in Table 1 . Table 1 Clinical data of 66 patients with BC spinal metastases. Age(year) Mean 51.39(14.051) Median 51.5 Range 26–76 Age of BC (year) Mean 52.52(14.231) Median 52 Range 27–78 OS (month) Mean 14.74(13.349) Median 10.5 Range 1–64 Tomita Mean 5.33(1.305) Median 5 Range 3–8 Revised Tokuhashi Mean10.21(1.732) Median 10 Range 7–14 SINS Mean 9.6(2.42) Median 9 Range 6–15 SMFS (month) Mean 13.83(16.631) Median 6 Range 0–66 Metabolism syndrome (+/−) 24/42 Menstrual status at BC (Yes/No) 35/31 TES/Separation surgery 41/25 Molecular Subtypes Luminal A 19 28.8% Luminal B 18 27.3% HER2-enriched 16 24.2% TNBC 13 19.7% metastasis location C 6 9.1% T 40 60.6% L 20 30.3% Multiple 13 34.8% Frankel Pre Post A 8 0 B 8 6 C 24 8 D 19 19 E 7 33 Abbreviations: BC, breast cancer; SMFS, spinal metastases free survival; OS, overall survival; TNBC, triple-negative breast cancer; SINS, Spinal Instability Neoplastic Score; TES, total en-bloc spondylectomy; 66 patients with a mean age of 51.39 years (median, 51.5 years; range, 26–76years) were involved in this study. The mean OS was 14.74 months (median,10.5 months; range, 1–64 months). 29 of the 66 patients died during the follow-up period. The clinical data showed that there are 6 Spinal metastases that occurred in the cervical spine, 40 in the thoracic spine and 20 in the lumbar spine. There were 22 patients with Multiple spinal metastases. No significant surgical complications occurred in all patients after TES or separation surgery. The preoperative pain and spinal cord function of all patients who underwent surgical treatment were relieved to varying degrees (Table 1 ), and no local recurrence was found during the follow-up period. Age, ALP, NLR, PLR, AGR, LMR, HALP, CEA, Ca125, Ca153, AJCC BC Stage, SINS Score, Tomita Score and Tokuhashi Score data were imported into X-tile 3.6.1 software to obtain the best cut-off values. 3.2. Univariate and multivariate analysis of prognostic factors for SMFS The 1-year,3-year, and 5-year SMFS rates were 81.8%±4.7%, 79%±5.4% and 26.6%±9.2% respectively, with a mean SMFS of 13.83 ± 16.631 months (95%CI 23.327–37.653). Potential prognostic factors were listed in Table 2 . Table 2 Univariate and multivariate analysis of Spinal metastases Free Survival (SMFS). Factors Univariate Multivariate Cases Events Χ 2 p B HR 95% CI p Age of BC ≤ 42 16 10 5.257 0.022 NS > 42 50 19 Menstrual status at BC (Yes/No) Yes 35 17 1.017 0.313 NI No 31 12 Metabolism syndrome (Yes/No) Yes 24 9 1.635 0.201 NI No 42 20 BC with visceral metastasis (Yes/No) Yes 18 8 7.137 0.008 NS No 48 21 BC CEA ≤ 2.8 32 14 0.539 0.463 NI > 2.8 34 15 BC Ca125 ≤ 39.7 55 22 4.325 0.038 NS > 39.7 11 7 BC Ca153 ≤ 53.8 55 24 6.5 0.011 NS > 53.8 11 5 ALP ≤ 91 37 13 4.359 0.037 1.486 4.42 1.609–12.145 0.004 > 91 29 16 BC AGR ≤ 1.1 6 4 3.052 0.081 NS > 1.1 60 25 BC LMR ≤ 4.9 41 20 3.261 0.071 1.290 3.634 1.215–10.873 0.021 > 4.9 25 9 BC NLR ≤ 4.1 58 24 4.832 0.028 NS > 4.1 8 5 BC PLR ≤ 97.7 6 5 2.739 0.098 NS > 97.7 60 24 BC HALP ≤ 58.5 59 24 1.745 0.187 NI > 58.5 7 5 ER negative 21 11 0.352 0.553 NI positive 45 18 PR negative 42 22 3.629 0.057 NS positive 24 7 Her-2 negative 50 24 0.072 0.788 NI positive 16 5 Ki-67 negative 31 11 0.918 0.338 NI positive 35 18 AJCC BC Stage ≤IIIB 25 8 6.71 0.010 1.605 4.977 1.477–16.769 0.010 >IIIB 41 21 Abbreviations: BC, breast cancer; AGR albumin-to-globulin ratio; LMR lymphocyte-to-monocyte ratio; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; HALP, hemoglobin and albumin levels and lymphocyte and platelet counts; ER, estrogen receptor; PR progesterone receptor; AJCC, American Joint Committee on Cancer; NI, not included in the multivariate analysis; NS, not significant in the multivariate analysis. Univariate analysis showed that patients with① Age of BC ≤ 42 (p = 0.022), ② BC with visceral metastasis (p = 0.008), ③ BC Ca125 > 39.7 (p = 0.038), ④ BC Ca153 > 53.8 (p = 0.011), ⑤ ALP > 91 (p = 0.037), ⑥ BC NLR > 4.1 (p = 0.028), ⑦ AJCC BC Stage >IIIB (p = 0.010) had lower SMFS. To avoid potential influencing factors being excluded due to the small sample size, we included all factors with a p-value 91 (p = 0.004, HR 4.42, 95%CI 1.609–12.145), ②BC LMR > 4.9 (p = 0.021, HR 3.634, 95%CI 1.215–10.873), ③AJCC BC Stage >IIIB (p = 0.010, HR 4.977, 95%CI 1.477–16.769) were independent prognostic factors for SMFS. The Kaplan–Meier curves of these three independent prognostic factors were shown in Fig. 1 . 3.3 Univariate and multivariate analysis of prognostic factors for OS By the end of the follow-up in December 2024, 29 patients died of BC. The 3-month,6-month,1-year, and 2–year OS rates were 93.8%±3%, 83.4%±4.8% ,74.2%±6.1%, and 43.2%±8.6% respectively, with a median OS was 14.74 ± 13.349 months (95%CI 20.188–34.316). Potential prognostic factors affecting OS were shown in Table 3 . Table 3 Univariate and multivariate analysis of Overall Survival (OS). Factors Univariate Multivariate Cases Events Χ 2 p B HR 95% CI p Age of BC ≤ 48 27 11 1.738 0.187 NI > 48 39 18 Age of Spinal metastases ≤ 54 39 16 2.056 0.152 NI > 54 27 13 Metabolism syndrome (Yes/No) Yes 24 9 0.192 0.662 NI No 42 20 Menstrual status at BC (Yes/No) Yes 35 17 2.035 0.154 NI No 31 12 AGR ≤ 1.4 41 22 6.683 0.010 NS > 1.4 25 7 LMR ≤ 3 11 7 4.573 0.032 NS > 3 55 22 NLR ≤ 4.2 53 24 1.610 0.205 NI > 4.2 13 5 PLR ≤ 277.1 47 20 2.839 0.092 NS > 277.1 19 9 HALP ≤ 43.5 52 21 2.458 0.117 NI > 43.5 14 8 Pre-op CEA ≤ 8.9 50 21 3.898 0.048 NS > 8.9 16 8 Pre-op Ca125 ≤ 115.2 59 5 10.341 0.001 2.183 8.871 1.814–43.373 0.007 > 115.2 7 11 Pre-op Ca153 ≤ 27.9 38 15 3.305 0.069 NS > 27.9 28 14 Pre-op ALP ≤ 62 12 5 1.458 0.227 NI > 62 54 24 AJCC BC Stage ≤ IIIB 25 8 1.328 0.249 NI >IIIB 41 21 ER negative 21 11 5.645 0.018 NS positive 45 18 PR negative 42 22 3.093 0.079 NS positive 24 7 Her-2 negative 50 24 0.227 0.634 NI positive 16 5 Ki-67 negative 31 11 3.317 0.069 NS positive 35 18 Pre-op KPS Score (≤ 50/>50) ≤ 50 29 12 0.299 0.584 NI > 50 37 17 SINS Score ≤ 11 50 22 1.143 0.285 NI > 11 16 7 Tomita Score ≤ 7 59 22 22.522 7 7 7 Tokuhashi Score ≤ 8 9 7 2.431 0.119 NI > 8 57 22 Spinal metastases with visceral metastasis (Yes/No) Yes 25 12 5.836 0.015 1.606 4.981 1.263–19.649 0.022 No 41 17 Multiple spinal metastases Yes 22 14 18.6 < 0.001 2.407 11.096 2.608–47.204 0.001 No 44 15 Strategy of spinal surgery TES 41 20 2.802 0.094 -3.174 0.042 0.005–0.332 0.003 Separation 25 9 Abbreviations: BC, breast cancer; AGR albumin-to-globulin ratio; LMR lymphocyte-to-monocyte ratio; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; HALP, hemoglobin and albumin levels and lymphocyte and platelet counts; ER, estrogen receptor; PR progesterone receptor; AJCC, American Joint Committee on Cancer; Pre-op ,preoperative; KPS, Karnofsky Performance Status; SINS, Spinal Instability Neoplastic Score ;TES, total en-bloc spondylectomy; NI, not included in the multivariate analysis; NS, not significant in the multivariate analysis. Univariate analysis using the Kaplan–Meier method showed that poorer OS was associated with ①AGR ≤ 1.4 (p = 0.010), ②LMR ≤ 3 (p = 0.032), ③Pre-op CEA > 8.9 (p = 0.048), ④Pre-op Ca125 > 115.2 (p = 0.001), ⑤ER negative (p = 0.018), ⑥Tomita Score > 7 (p < 0.001), ⑦Spinal metastases with visceral metastasis (p = 0.015), ⑧Multiple spinal metastases (p < 0.001). To avoid potential influencing factors being excluded due to the small sample size, we included all factors with a p-value 115.2 (p = 0.007,HR 8.871,95%CI 1.814–43.373), ②Tomita Score > 7 (p = 0.038,HR 4.567,95%CI 1.089–19.156), ③Spinal metastases with visceral metastasis (p = 0.022,HR 4.981,95%CI 1.263–19.649), ④Multiple spinal metastases (p = 0.001,HR 11.096,95%CI 2.608–47.204) and ⑤Strategy of spinal surgery (p = 0.003,HR 0.042, 95%CI 0.005–0.332) were independent prognostic factors for OS. The Kaplan–Meier curves of these 5 independent prognostic factors were shown in Fig. 2 . 4. Discussion Breast cancer is the most common malignant tumor in female patients. With the continuous optimization of treatment regimens, the mortality rate of breast cancer has decreased, while the incidence of metastatic disease has gradually increased. According to statistics, approximately 8% of breast cancer patients develop bone metastases among which the spine is the most common site of metastasis [ 7 – 9 ]. Spinal metastases are often asymptomatic in the early stage. Severe pain occurs when pathological vertebral fractures develop. When the spinal cord and nerve roots are compressed, neurological dysfunction can be induced, which seriously impairs the patients’ quality of life. Given the insidious onset and adverse outcomes of spinal metastases, early warning for spinal metastases in breast cancer patients is particularly important. Therefore, our study focused on SMFS of BC patients with spinal metastases. The results showed that ALP levels > 91 U/L, BC LMR > 4.9, and AJCC breast cancer stage > IIIB could significantly affect the SMFS of BC patients. ALP has been clearly identified as a biomarker for bone turnover and mineralization, and its serum level is correlated with increased osteoblast activity [ 10 , 11 ]. In osteolytic bone metastases, elevated ALP levels are secondary to local osteogenic responses; in osteoblastic bone metastases, elevated ALP levels are secondary to local stimulation of osteoblasts [ 10 ]. Based on this well-established pathophysiological mechanism, the study by Karhade AV et al [ 12 ] regarded elevated serum ALP as an indicator for evaluating the total metastatic tumor burden, and pointed out that elevated serum ALP is an independent prognostic factor for survival in patients with spinal metastases. Our study also used serum ALP as a potential prognostic factor affecting the SMFS and OS of BC patients with spinal metastases. Statistical analysis showed that BC patients with ALP ≤ 91 U/L developed spinal metastases earlier. This finding confirms that ALP can provide a reference for predicting spinal metastases in BC patients. LMR, as a simple hematological biomarker reflecting the body’s immune status and inflammatory response, has been extensively investigated in prognostic assessment across fields such as malignant tumors and autoimmune diseases in recent years. A large number of research has demonstrated that a low LMR indicates poor prognosis and is closely associated with advanced-stage cancer, hypoproteinemia, and bone metastases [ 13 , 14 ]. Similarly, in our study, a low LMR was identified as a risk factor for both SMFS and OS in BC patients. A lower LMR correlates with earlier onset of spinal metastases and shorter post-metastasis survival time. According to the 8th edition of the AJCC Breast Cancer Staging System, Stage IIIB is defined as T4N0–2M0. A study by Kurundkar A et al [ 15 ] demonstrated that in the clinical prognostic stage grouping, the comparison between Stage IIIB and Stage IIIC showed marginal significance. In our study, the optimal cutoff value was set at Stage IIIB, which was determined using the X-tile software. Statistical analysis revealed that breast cancer patients with AJCC stage > IIIB developed spinal metastases at an earlier time point, thereby providing evidence for early bone monitoring in high-risk patient populations. In recent years, tumor markers have been widely used as reliable tools for assisting in the detection and diagnosis of breast cancer [ 16 , 17 ]. Although CA-125 is not regarded as a definitive diagnostic tool for breast cancer, it can play a role in confirming the diagnosis in specific cases. CA-125 is often used in combination with CEA and CA15-3 for the diagnosis of breast cancer, and it has relatively high specificity despite its relatively low sensitivity. A study by Norum et al [ 18 ] found that the level of CA-125 increases initially when tumor metastasis occurs. Elevated CA-125 levels have also been confirmed to be associated with increased tumor size and the occurrence of lymph node metastasis [ 19 ]. A study reported by Feng et al [ 20 ] showed that the CA-125 levels in BC patients with bone metastasis were significantly higher than those in BC patients without bone metastasis and patients with benign lesions. Similarly, in our study, the CA-125 levels in BC patients with spinal metastasis could significantly affect the survival time after spinal metastasis. The Tomita score was proposed in 2001 as a standard system for evaluating the prognosis of spinal metastases. Multiple studies have reported a significant correlation between the survival rate of patients with spinal metastases and the Tomita score [ 21 – 24 ]. The Tomita score is favored for its simplicity in design and the easy accessibility of the required data, and it is often used alone as a clinical scoring tool or in combination with other scoring systems [ 25 , 26 ]. In our study, all patients underwent routine preoperative assessments using the Tomita score, Tokuhashi score, and SINS score, respectively. Subsequent survival analysis results showed that patients with a Tomita score > 7 had shorter survival time after spinal metastasis. The Tomita score was identified as an independent prognostic factor for OS. Moreover, spinal metastases complicated with visceral metastases and multi-segmental metastases are not only important components of the Tomita score, but also each of them can significantly affect the survival time after spinal metastasis. Meanwhile, in our study, the type of spinal surgery was also an independent prognostic factor for OS. For the treatment of spinal metastases, we usually select the surgical approach in accordance with the following principles: For patients with solitary spinal metastasis or two adjacent segmental metastases, if there is no visceral metastasis or the condition can be controlled by systemic therapy, TES surgery should be chosen whenever possible to eliminate metastatic lesions. For patients with multiple metastases or combined visceral metastases, who have severe instability of the spinal alignment and suffer from serious spinal cord neurological deficits, palliative Separation surgery is adopted to salvage the patients' neurological function and improve their quality of life. Although the patients’ treatment regimens were not randomized, those who underwent TES surgery did not experience local recurrence during the follow-up period. Patients who received decompression surgery achieved restored stability of the spinal alignment and improved quality of life after the operation. All patients who underwent spinal surgery showed varying degrees of improvement in Frankel grade. Furthermore, the significant impact of the metastatic spinal segments and the type of spinal surgery on survival time after spinal metastasis suggests, to a certain extent, the feasibility and necessity of surgical treatment for spinal metastases. This study has several limitations. First, it is a single-center study with a small sample size. Insufficient sample size may lead to the exclusion of many potential prognostic factors. Second, all patients included in the study underwent surgical intervention, while patients with spinal metastases who were unable to undergo surgery for various reasons were not included. Therefore, potential selection bias is inevitable. Finally, given the strong correlation with breast cancer subtypes, this study did not investigate the impact of systemic therapy after breast cancer treatment and systemic therapy following spinal metastasis surgery on SMFS and OS. Thus, it failed to reflect the important role of systemic therapy in BC treatment strategies. Therefore, future studies need to employ larger sample sizes and incorporate a broader range of prognostic factors. 5. Conclusions ALP > 91, BC LMR > 4.9 and AJCC BC Stage >IIIB can significantly affect SMFS of BC patients. Pre-op Ca125 > 115.2, Tomita Score > 7, Spinal metastases with visceral metastasis, Multiple spinal metastases, and Strategy of spinal surgery can significantly affect OS of BC patients after spinal metastases. Abbreviations The following abbreviations are used in this manuscript: BC breast cancer SREs skeletal-related events SMFS spinal metastases free survival; OS overall survival TNBC triple-negative breast cancer ER estrogen receptor PR progesterone receptor NLR neutrophil-to-lymphocyte ratio PLR platelet-to-lymphocyte ratio AGR albumin-to-globulin ratio LMR lymphocyte-to-monocyte ratio HALP Hemoglobin, albumin, lymphocyte and platelet counts KPS Karnofsky Performance Status TES total en-bloc spondylectomy SINS Spinal Instability Neoplastic Score AJCC Union International Against cancer Declarations Clinical trial number: not applicable Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Competing Interests The authors have no relevant financial or non-financial interests to disclose. Author Contributions Conceptualization, Formal Analysis, Software, Writing-original draft: Ming Lei. Data curation, Validation: Haimei Ren. Ming Lei and Haimei Ren contributed equally to this work. Funding acquisition, Supervision, Writing-review & editing: Yibin Zhou. Resources, Visualization: Di Li, All the authors have read and agreed to the published version of the manuscript. The authors did not use generative AI or AI-assisted technologies in the development of this manuscript. Data Availability All data generated or analyzed during the current study are included in this published article and its supplementary information files. Ethics approval The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of Affiliated Hospital of Hebei University (Approval No. HDFYLL-IIT-2025-141). 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Analysis of the predictive role and new proposal for surgical strategies based on the modified Tomita and Tokuhashi scoring systems for spinal metastasis. World J Surg Oncol. 2014;12:245. 10.1186/1477-7819-12-245 . Leithner A, Radl R, Gruber G, Hochegger M, Leithner K, Welkerling H, Rehak P, Windhager R. Predictive value of seven preoperative prognostic scoring systems for spinal metastases. Eur Spine J. 2008;17(11):1488–95. 10.1007/s00586-008-0763-1 . Epub 2008 Sep 12. Ulmar B, Reichel H, Catalkaya S, Naumann U, Schmidt R, Gerstner S, Huch K. Evaluation and modification of the Tomita score in 217 patients with vertebral metastases. Onkologie. 2007;30(8–9):414–8. 10.1159/000104491 . Aoude A, Amiot LP. A comparison of the modified Tokuhashi and Tomita scores in determining prognosis for patients afflicted with spinal metastasis. Can J Surg. 2014;57(3):188–93. 10.1503/cjs.012013 . Tang V, Harvey D, Park Dorsay J, Jiang S, Rathbone MP. Prognostic indicators in metastatic spinal cord compression: using functional independence measure and Tokuhashi scale to optimize rehabilitation planning. Spinal Cord. 2007;45(10):671–7. 10.1038/sj.sc.3102024 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 05 May, 2026 Reviews received at journal 20 Apr, 2026 Reviews received at journal 15 Apr, 2026 Reviewers agreed at journal 13 Apr, 2026 Reviewers agreed at journal 13 Apr, 2026 Reviewers invited by journal 10 Apr, 2026 Editor invited by journal 10 Apr, 2026 Editor assigned by journal 09 Apr, 2026 Submission checks completed at journal 07 Apr, 2026 First submitted to journal 07 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9213252","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":623322840,"identity":"9d7ecdcb-acc7-4987-889f-faf4fc53ccae","order_by":0,"name":"Ming Lei","email":"","orcid":"","institution":"Affiliated Hospital of Hebei University","correspondingAuthor":false,"prefix":"","firstName":"Ming","middleName":"","lastName":"Lei","suffix":""},{"id":623322841,"identity":"49964449-aa08-4e10-8270-6e616c7b18f4","order_by":1,"name":"Haimei Ren","email":"","orcid":"","institution":"Affiliated Hospital of Hebei University","correspondingAuthor":false,"prefix":"","firstName":"Haimei","middleName":"","lastName":"Ren","suffix":""},{"id":623322842,"identity":"3c552abe-a03d-4f22-9352-c7ded86a472e","order_by":2,"name":"Yibin Zhou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3UlEQVRIie3RuwrCMBSA4SOBuES7HkHi5hwIdBJ8lYSCk4Jjhw4VxQ7eXsXRsUXoFPduVnwB3ZzU4qrYujnkGzLlJzkJgGX9IepEyeni97hTnya58oPypInGk2gGsrVMPZGbtDzhoFxszPd6mw27rdOMVLgYxJ5ASiTEQ+rrkIITLdT3hEySfMwor4WHNNO7NqA5bCucgkyS2nqQaUNB4KgsKWZhAvWcMHdcrFUTJfSSMheqJa9HjpVERj1UJmWls3Q2xVde7w/eP56T680PuBOtvidv2G/bLcuyrI+eUppJkzJOlewAAAAASUVORK5CYII=","orcid":"","institution":"Affiliated Hospital of Hebei University","correspondingAuthor":true,"prefix":"","firstName":"Yibin","middleName":"","lastName":"Zhou","suffix":""},{"id":623322843,"identity":"79f12cad-a8bb-4163-aeee-635dfa4f79d7","order_by":3,"name":"Di Li","email":"","orcid":"","institution":"Affiliated Hospital of Hebei University","correspondingAuthor":false,"prefix":"","firstName":"Di","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2026-03-24 14:27:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9213252/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9213252/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107257885,"identity":"031fd007-4751-482e-8fd7-ae52c1668ba7","added_by":"auto","created_at":"2026-04-19 12:35:39","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":259727,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan–Meier curves of SMFS for (A) ALP, (B) BC LMR, (C) AJCC BC stage\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9213252/v1/9f7482115ccdb378dc352e9d.png"},{"id":107484587,"identity":"34e9b8cc-f1bc-4d1a-9d95-9f2ad029bdce","added_by":"auto","created_at":"2026-04-22 02:32:26","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":369126,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan–Meier curves of SMFS for (A) Pre-op Ca125, (B) Tomita Score, (C) Spinal metastases with visceral metastasis, (D) Multiple spinal metastases, (E) Strategy of spinal surgery\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9213252/v1/6777655644370f636e00c454.png"},{"id":107486917,"identity":"e0c094d9-1f57-451e-b946-52edbc473a6c","added_by":"auto","created_at":"2026-04-22 02:39:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1084395,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9213252/v1/0b7b2ba6-d77f-4b9b-82fe-2a5c186bb6b7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Factors Influencing Survival and Prognosis in Patients with Spinal Metastases from Breast Cancer","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eAccording to the 2020 Global Cancer Statistics Report, breast cancer (BC) is the most common malignancy. It is estimated that there were about 2.3\u0026nbsp;million new cases of breast cancer that year, accounting for 11.7% of all new cancer cases. At the same time, breast cancer is the fifth leading cause of cancer-related deaths worldwide, accounting for 6.9% of all deaths [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe reduction in BC mortality may be related to the relatively mild biology of BC and the continuous optimization of chemoradiotherapy, targeted drugs, and hormone therapy strategies in recent years. At the same time, the incidence of metastatic BC has also increased [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. It is estimated that 20%-30% of BCs will metastasize. Bone metastases account for approximately 60\u0026ndash;70% of all metastatic BCs [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDue to the large number of spinal segments, abundant blood supply and slow blood flow, the spine is the most common site of breast bone metastasis [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Bone metastases can lead to skeletal-related events (SREs). Hypercalcemia, pathological fractures, spinal cord compression, and painful pathological fractures are the main complications of bone metastases [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. These complications seriously affect the patient's neurological function, quality of life, and survival.\u003c/p\u003e \u003cp\u003eThe treatment of BC spinal metastases requires multidisciplinary cooperation, which can be roughly divided into two categories: systemic treatment and local treatment. Systemic therapy includes analgesic drug therapy, endocrine therapy, chemotherapy, bisphosphonates, immunotherapy and targeted therapy. Local treatment includes radiation therapy and surgery. In previous treatments, patients have a limited life expectancy when metastases indicate that the malignancy patient's disease has entered the terminal stage. Therefore, the length of life expectancy directly affects the choice of treatment strategy [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, with the development of treatment methods, the life expectancy of cancer patients has increased significantly in recent years. The choice of treatment modality depends not only on the patient's survival but also on the sensitivity of the tumor to chemoradiotherapy and the expected effect of surgical treatment [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRecently, several studies have reported the prognosis factors of patients with BC and give some recommendations for treatment opinions. However, only a limited number of previous studies have especially focused on spinal metastases of BC. The aim of this study is to analyze the clinical data of BC patients with spinal metastases who underwent surgical treatment in our hospital, and to explore the potential prognostic factors of BC patients with spinal metastases.\u003c/p\u003e"},{"header":"2. Patients and Methods","content":"\u003cp\u003eThis research was examined and approved by the Ethics Committee of our hospital (Approval No. HDFYLL-IIT-2025-141). All clinical investigations were conducted according to the principles expressed in the Declaration of Helsinki.The authors did not use generative AI or AI-assisted technologies in the development of this manuscript.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Patients\u003c/h2\u003e \u003cp\u003eFrom January 2016 to December 2024, a total of 479 patients were diagnosed with BC in our hospital, including 182 patients with metastatic BC. Of these 182 patients, 114 patients developed spinal metastases, and 66 of these patients underwent spinal surgery.\u003c/p\u003e \u003cp\u003eWe performed a detailed review and analysis of these 66 patient's medical records, images, and pathology reports. All patients were followed up every 3 months for the first 6 months after surgery, then every 6 months for the next 2 years, and annually thereafter. All patients were all followed up until December 2024 or until death. The final statuses (died of disease/alive with disease) were acquired through telephone interviews.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Treatment\u003c/h2\u003e \u003cp\u003eAll patients underwent lumpectomy plus regional lymphadenectomy at the time of initial diagnosis of BC and received corresponding systemic treatment according to the pathological results. After spinal metastases were detected, all patients received surgical interventions including total en-bloc spondylectomy (TES) or separation surgery. Surgery indications are as follows: (1) Pathological fractures and neurological dysfunction due to spinal metastases (2) The estimated preoperative life expectancy is greater than 3 months. Personalized surgical strategies were determined according to Tomita, revised Tokuhashi, and Spinal Instability Neoplastic Score (SINS). All patients received subsequent chemotherapy, radiotherapy, endocrine/targeted therapy and/or bisphosphonate therapy according to the advice of the attending oncologists 1 month after spinal surgery.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Statistical analysis\u003c/h2\u003e \u003cp\u003eA series of clinical factors were analyzed to identify independent variables that could affect prognosis. Potential factors include: (1) age, (2) age of BC (3)menstrual status at the initial diagnosis of BC, (4) metabolic syndrome, (5) laboratory tests including CEA, CA125, CA153, alkaline phosphatase(ALP), albumin-to-globulin ratio (AGR), lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio(NLR); platelet-to-lymphocyte ratio(PLR); hemoglobin and albumin levels and lymphocyte and platelet counts(HALP) in the diagnosis of BC within one week before breast surgery and spinal surgery, (6) BC AJCC TNM stage (7) pathological results, including ER, PR, Her-2 and Ki-67, (8) BC/spinal metastases diagnosed with visceral metastasis, (9) spinal metastases segments, (10) SINS Score, Tomita Score, Tokuhashi Score, Frankel score, pre-operative KPS score, (11) strategy of spinal surgery(TES surgery/separation surgery).\u003c/p\u003e \u003cp\u003eThe optimal cut-off values of age, ALP, NLR, PLR, AGR, LMR, HALP, CEA, Ca125, Ca153, AJCC BC Stage, SINS Score, Tomita Score and Tokuhashi Score were determined by X-tile 3.6.1 software 20 (Yale University, New Haven, CT, USA).\u003c/p\u003e \u003cp\u003eSpinal metastases free survival (SMFS) was defined as the date from RCC diagnosis to Spinal metastases. Overall survival (OS) was measured as the date from Spinal metastases to cancer-related death or December 2024. Univariate survival analyses for potential prognostic factors associated with OS and SMFS were conducted using the Kaplan\u0026ndash;Meier approach. Variables with p\u0026thinsp;\u0026lt;\u0026thinsp;0.1 in univariate testing were subsequently entered into a multivariate Cox proportional hazards regression model to determine independent prognostic indicators for OS and SMFS. A two‑sided p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was defined as statistically significant. All statistical procedures were performed using IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp., Armonk, NY, USA)\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Demographics and Clinical Characteristics\u003c/h2\u003e \u003cp\u003eThe demographic characteristics and clinical characteristics of the 66 BC patients with Spinal metastases were shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical data of 66 patients with BC spinal metastases.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge(year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean 51.39(14.051)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedian 51.5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRange 26\u0026ndash;76\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of BC (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean 52.52(14.231)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedian 52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRange 27\u0026ndash;78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOS (month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean 14.74(13.349)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedian 10.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRange 1\u0026ndash;64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTomita\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean 5.33(1.305)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedian 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRange 3\u0026ndash;8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRevised Tokuhashi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean10.21(1.732)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedian 10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRange 7\u0026ndash;14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSINS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean 9.6(2.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedian 9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRange 6\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSMFS (month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean 13.83(16.631)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedian 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRange 0\u0026ndash;66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMetabolism syndrome\u003c/p\u003e \u003cp\u003e(+/\u0026minus;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24/42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMenstrual status at BC (Yes/No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e35/31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTES/Separation surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41/25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMolecular Subtypes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLuminal A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLuminal B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHER2-enriched\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTNBC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emetastasis location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMultiple\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrankel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePre\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eAbbreviations: BC, breast cancer; SMFS, spinal metastases free survival; OS, overall survival; TNBC, triple-negative breast cancer; SINS, Spinal Instability Neoplastic Score; TES, total en-bloc spondylectomy;\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e66 patients with a mean age of 51.39 years (median, 51.5 years; range, 26\u0026ndash;76years) were involved in this study. The mean OS was 14.74 months (median,10.5 months; range, 1\u0026ndash;64 months). 29 of the 66 patients died during the follow-up period. The clinical data showed that there are 6 Spinal metastases that occurred in the cervical spine, 40 in the thoracic spine and 20 in the lumbar spine. There were 22 patients with Multiple spinal metastases. No significant surgical complications occurred in all patients after TES or separation surgery. The preoperative pain and spinal cord function of all patients who underwent surgical treatment were relieved to varying degrees (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), and no local recurrence was found during the follow-up period.\u003c/p\u003e \u003cp\u003eAge, ALP, NLR, PLR, AGR, LMR, HALP, CEA, Ca125, Ca153, AJCC BC Stage, SINS Score, Tomita Score and Tokuhashi Score data were imported into X-tile 3.6.1 software to obtain the best cut-off values.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Univariate and multivariate analysis of prognostic factors for SMFS\u003c/h2\u003e \u003cp\u003eThe 1-year,3-year, and 5-year SMFS rates were 81.8%\u0026plusmn;4.7%, 79%\u0026plusmn;5.4% and 26.6%\u0026plusmn;9.2% respectively, with a mean SMFS of 13.83\u0026thinsp;\u0026plusmn;\u0026thinsp;16.631 months (95%CI 23.327\u0026ndash;37.653). Potential prognostic factors were listed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate and multivariate analysis of Spinal metastases Free Survival (SMFS).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFactors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c10\" namest=\"c7\"\u003e \u003cp\u003eMultivariate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEvents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eΧ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge of BC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e5.257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMenstrual status at BC (Yes/No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.313\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMetabolism syndrome (Yes/No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.635\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBC with visceral metastasis (Yes/No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e7.137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBC CEA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.539\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.463\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBC Ca125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;39.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e4.325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;39.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBC Ca153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;53.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;53.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eALP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e4.359\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.486\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e4.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.609\u0026ndash;12.145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBC AGR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBC LMR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;4.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3.261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.290\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3.634\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.215\u0026ndash;10.873\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;4.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBC NLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e4.832\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBC PLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;97.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2.739\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;97.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBC HALP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;58.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.745\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;58.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eER\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003enegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.352\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.553\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003enegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3.629\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHer-2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003enegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.788\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eKi-67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003enegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.918\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.338\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAJCC BC Stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;IIIB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e6.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.605\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e4.977\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.477\u0026ndash;16.769\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;IIIB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eAbbreviations: BC, breast cancer; AGR albumin-to-globulin ratio; LMR lymphocyte-to-monocyte ratio; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; HALP, hemoglobin and albumin levels and lymphocyte and platelet counts; ER, estrogen receptor; PR progesterone receptor; AJCC, American Joint Committee on Cancer; NI, not included in the multivariate analysis; NS, not significant in the multivariate analysis.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eUnivariate analysis showed that patients with① Age of BC\u0026thinsp;\u0026le;\u0026thinsp;42 (p\u0026thinsp;=\u0026thinsp;0.022), ② BC with visceral metastasis (p\u0026thinsp;=\u0026thinsp;0.008), ③ BC Ca125\u0026thinsp;\u0026gt;\u0026thinsp;39.7 (p\u0026thinsp;=\u0026thinsp;0.038), ④ BC Ca153\u0026thinsp;\u0026gt;\u0026thinsp;53.8 (p\u0026thinsp;=\u0026thinsp;0.011), ⑤ ALP\u0026thinsp;\u0026gt;\u0026thinsp;91 (p\u0026thinsp;=\u0026thinsp;0.037), ⑥ BC NLR\u0026thinsp;\u0026gt;\u0026thinsp;4.1 (p\u0026thinsp;=\u0026thinsp;0.028), ⑦ AJCC BC Stage \u0026gt;IIIB (p\u0026thinsp;=\u0026thinsp;0.010) had lower SMFS.\u003c/p\u003e \u003cp\u003eTo avoid potential influencing factors being excluded due to the small sample size, we included all factors with a p-value\u0026lt;0.1 in the multivariate analysis.\u003c/p\u003e \u003cp\u003eResults from multivariate analysis showed that ①ALP\u0026thinsp;\u0026gt;\u0026thinsp;91 (p\u0026thinsp;=\u0026thinsp;0.004, HR 4.42, 95%CI 1.609\u0026ndash;12.145), ②BC LMR\u0026thinsp;\u0026gt;\u0026thinsp;4.9 (p\u0026thinsp;=\u0026thinsp;0.021, HR 3.634, 95%CI 1.215\u0026ndash;10.873), ③AJCC BC Stage \u0026gt;IIIB (p\u0026thinsp;=\u0026thinsp;0.010, HR 4.977, 95%CI 1.477\u0026ndash;16.769) were independent prognostic factors for SMFS. The Kaplan\u0026ndash;Meier curves of these three independent prognostic factors were shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Univariate and multivariate analysis of prognostic factors for OS\u003c/h2\u003e \u003cp\u003eBy the end of the follow-up in December 2024, 29 patients died of BC. The 3-month,6-month,1-year, and 2\u0026ndash;year OS rates were 93.8%\u0026plusmn;3%, 83.4%\u0026plusmn;4.8% ,74.2%\u0026plusmn;6.1%, and 43.2%\u0026plusmn;8.6% respectively, with a median OS was 14.74\u0026thinsp;\u0026plusmn;\u0026thinsp;13.349 months (95%CI 20.188\u0026ndash;34.316). Potential prognostic factors affecting OS were shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate and multivariate analysis of Overall Survival (OS).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFactors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c10\" namest=\"c7\"\u003e \u003cp\u003eMultivariate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEvents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eΧ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge of BC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.738\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge of Spinal metastases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMetabolism syndrome (Yes/No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.662\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMenstrual status at BC (Yes/No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAGR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e6.683\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLMR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e4.573\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.610\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;277.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2.839\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;277.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHALP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;43.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2.458\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;43.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePre-op CEA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;8.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3.898\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;8.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePre-op Ca125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;115.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e10.341\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2.183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e8.871\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.814\u0026ndash;43.373\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;115.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePre-op Ca153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;27.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3.305\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;27.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePre-op ALP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.458\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAJCC BC Stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le; IIIB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.328\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.249\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;IIIB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eER\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003enegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e5.645\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003enegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3.093\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHer-2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003enegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.634\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eKi-67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003enegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3.317\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePre-op KPS Score (\u0026le;\u0026thinsp;50/\u0026gt;50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.299\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.584\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSINS Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.285\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTomita Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e22.522\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.519\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e4.567\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.089\u0026ndash;19.156\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTokuhashi Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2.431\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" morerows=\"1\" nameend=\"c10\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSpinal metastases with visceral metastasis (Yes/No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e5.836\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.606\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e4.981\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.263\u0026ndash;19.649\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMultiple spinal metastases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e18.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2.407\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e11.096\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2.608\u0026ndash;47.204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStrategy of spinal surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2.802\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-3.174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.005\u0026ndash;0.332\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSeparation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eAbbreviations: BC, breast cancer; AGR albumin-to-globulin ratio; LMR lymphocyte-to-monocyte ratio; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; HALP, hemoglobin and albumin levels and lymphocyte and platelet counts; ER, estrogen receptor; PR progesterone receptor; AJCC, American Joint Committee on Cancer; Pre-op ,preoperative; KPS, Karnofsky\u0026nbsp;Performance Status;\u0026nbsp;SINS, Spinal Instability Neoplastic Score ;TES, total en-bloc spondylectomy; NI, not included in the multivariate analysis; NS, not significant in the multivariate analysis.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eUnivariate analysis using the Kaplan\u0026ndash;Meier method showed that poorer OS was associated with ①AGR\u0026thinsp;\u0026le;\u0026thinsp;1.4 (p\u0026thinsp;=\u0026thinsp;0.010), ②LMR\u0026thinsp;\u0026le;\u0026thinsp;3 (p\u0026thinsp;=\u0026thinsp;0.032), ③Pre-op CEA\u0026thinsp;\u0026gt;\u0026thinsp;8.9 (p\u0026thinsp;=\u0026thinsp;0.048), ④Pre-op Ca125\u0026thinsp;\u0026gt;\u0026thinsp;115.2 (p\u0026thinsp;=\u0026thinsp;0.001), ⑤ER negative (p\u0026thinsp;=\u0026thinsp;0.018), ⑥Tomita Score\u0026thinsp;\u0026gt;\u0026thinsp;7 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), ⑦Spinal metastases with visceral metastasis (p\u0026thinsp;=\u0026thinsp;0.015), ⑧Multiple spinal metastases (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eTo avoid potential influencing factors being excluded due to the small sample size, we included all factors with a p-value\u0026lt;0.1 in the multivariate analysis.\u003c/p\u003e \u003cp\u003eMultivariate analysis showed that ①Pre-op Ca125\u0026thinsp;\u0026gt;\u0026thinsp;115.2 (p\u0026thinsp;=\u0026thinsp;0.007,HR 8.871,95%CI 1.814\u0026ndash;43.373), ②Tomita Score\u0026thinsp;\u0026gt;\u0026thinsp;7 (p\u0026thinsp;=\u0026thinsp;0.038,HR 4.567,95%CI 1.089\u0026ndash;19.156), ③Spinal metastases with visceral metastasis (p\u0026thinsp;=\u0026thinsp;0.022,HR 4.981,95%CI 1.263\u0026ndash;19.649), ④Multiple spinal metastases (p\u0026thinsp;=\u0026thinsp;0.001,HR 11.096,95%CI 2.608\u0026ndash;47.204) and ⑤Strategy of spinal surgery (p\u0026thinsp;=\u0026thinsp;0.003,HR 0.042, 95%CI 0.005\u0026ndash;0.332) were independent prognostic factors for OS. The Kaplan\u0026ndash;Meier curves of these 5 independent prognostic factors were shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eBreast cancer is the most common malignant tumor in female patients. With the continuous optimization of treatment regimens, the mortality rate of breast cancer has decreased, while the incidence of metastatic disease has gradually increased. According to statistics, approximately 8% of breast cancer patients develop bone metastases among which the spine is the most common site of metastasis [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSpinal metastases are often asymptomatic in the early stage. Severe pain occurs when pathological vertebral fractures develop. When the spinal cord and nerve roots are compressed, neurological dysfunction can be induced, which seriously impairs the patients\u0026rsquo; quality of life. Given the insidious onset and adverse outcomes of spinal metastases, early warning for spinal metastases in breast cancer patients is particularly important. Therefore, our study focused on SMFS of BC patients with spinal metastases. The results showed that ALP levels\u0026thinsp;\u0026gt;\u0026thinsp;91 U/L, BC LMR\u0026thinsp;\u0026gt;\u0026thinsp;4.9, and AJCC breast cancer stage\u0026thinsp;\u0026gt;\u0026thinsp;IIIB could significantly affect the SMFS of BC patients.\u003c/p\u003e \u003cp\u003eALP has been clearly identified as a biomarker for bone turnover and mineralization, and its serum level is correlated with increased osteoblast activity [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In osteolytic bone metastases, elevated ALP levels are secondary to local osteogenic responses; in osteoblastic bone metastases, elevated ALP levels are secondary to local stimulation of osteoblasts [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Based on this well-established pathophysiological mechanism, the study by Karhade AV et al [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] regarded elevated serum ALP as an indicator for evaluating the total metastatic tumor burden, and pointed out that elevated serum ALP is an independent prognostic factor for survival in patients with spinal metastases. Our study also used serum ALP as a potential prognostic factor affecting the SMFS and OS of BC patients with spinal metastases. Statistical analysis showed that BC patients with ALP\u0026thinsp;\u0026le;\u0026thinsp;91 U/L developed spinal metastases earlier. This finding confirms that ALP can provide a reference for predicting spinal metastases in BC patients.\u003c/p\u003e \u003cp\u003eLMR, as a simple hematological biomarker reflecting the body\u0026rsquo;s immune status and inflammatory response, has been extensively investigated in prognostic assessment across fields such as malignant tumors and autoimmune diseases in recent years. A large number of research has demonstrated that a low LMR indicates poor prognosis and is closely associated with advanced-stage cancer, hypoproteinemia, and bone metastases [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Similarly, in our study, a low LMR was identified as a risk factor for both SMFS and OS in BC patients. A lower LMR correlates with earlier onset of spinal metastases and shorter post-metastasis survival time.\u003c/p\u003e \u003cp\u003eAccording to the 8th edition of the AJCC Breast Cancer Staging System, Stage IIIB is defined as T4N0\u0026ndash;2M0. A study by Kurundkar A et al [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] demonstrated that in the clinical prognostic stage grouping, the comparison between Stage IIIB and Stage IIIC showed marginal significance. In our study, the optimal cutoff value was set at Stage IIIB, which was determined using the X-tile software. Statistical analysis revealed that breast cancer patients with AJCC stage\u0026thinsp;\u0026gt;\u0026thinsp;IIIB developed spinal metastases at an earlier time point, thereby providing evidence for early bone monitoring in high-risk patient populations.\u003c/p\u003e \u003cp\u003eIn recent years, tumor markers have been widely used as reliable tools for assisting in the detection and diagnosis of breast cancer [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Although CA-125 is not regarded as a definitive diagnostic tool for breast cancer, it can play a role in confirming the diagnosis in specific cases. CA-125 is often used in combination with CEA and CA15-3 for the diagnosis of breast cancer, and it has relatively high specificity despite its relatively low sensitivity. A study by Norum et al [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] found that the level of CA-125 increases initially when tumor metastasis occurs. Elevated CA-125 levels have also been confirmed to be associated with increased tumor size and the occurrence of lymph node metastasis [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. A study reported by Feng et al [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] showed that the CA-125 levels in BC patients with bone metastasis were significantly higher than those in BC patients without bone metastasis and patients with benign lesions. Similarly, in our study, the CA-125 levels in BC patients with spinal metastasis could significantly affect the survival time after spinal metastasis.\u003c/p\u003e \u003cp\u003eThe Tomita score was proposed in 2001 as a standard system for evaluating the prognosis of spinal metastases. Multiple studies have reported a significant correlation between the survival rate of patients with spinal metastases and the Tomita score [\u003cspan additionalcitationids=\"CR22 CR23\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The Tomita score is favored for its simplicity in design and the easy accessibility of the required data, and it is often used alone as a clinical scoring tool or in combination with other scoring systems [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In our study, all patients underwent routine preoperative assessments using the Tomita score, Tokuhashi score, and SINS score, respectively. Subsequent survival analysis results showed that patients with a Tomita score\u0026thinsp;\u0026gt;\u0026thinsp;7 had shorter survival time after spinal metastasis. The Tomita score was identified as an independent prognostic factor for OS. Moreover, spinal metastases complicated with visceral metastases and multi-segmental metastases are not only important components of the Tomita score, but also each of them can significantly affect the survival time after spinal metastasis.\u003c/p\u003e \u003cp\u003eMeanwhile, in our study, the type of spinal surgery was also an independent prognostic factor for OS. For the treatment of spinal metastases, we usually select the surgical approach in accordance with the following principles: For patients with solitary spinal metastasis or two adjacent segmental metastases, if there is no visceral metastasis or the condition can be controlled by systemic therapy, TES surgery should be chosen whenever possible to eliminate metastatic lesions. For patients with multiple metastases or combined visceral metastases, who have severe instability of the spinal alignment and suffer from serious spinal cord neurological deficits, palliative Separation surgery is adopted to salvage the patients' neurological function and improve their quality of life.\u003c/p\u003e \u003cp\u003eAlthough the patients\u0026rsquo; treatment regimens were not randomized, those who underwent TES surgery did not experience local recurrence during the follow-up period. Patients who received decompression surgery achieved restored stability of the spinal alignment and improved quality of life after the operation. All patients who underwent spinal surgery showed varying degrees of improvement in Frankel grade. Furthermore, the significant impact of the metastatic spinal segments and the type of spinal surgery on survival time after spinal metastasis suggests, to a certain extent, the feasibility and necessity of surgical treatment for spinal metastases.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, it is a single-center study with a small sample size. Insufficient sample size may lead to the exclusion of many potential prognostic factors. Second, all patients included in the study underwent surgical intervention, while patients with spinal metastases who were unable to undergo surgery for various reasons were not included. Therefore, potential selection bias is inevitable. Finally, given the strong correlation with breast cancer subtypes, this study did not investigate the impact of systemic therapy after breast cancer treatment and systemic therapy following spinal metastasis surgery on SMFS and OS. Thus, it failed to reflect the important role of systemic therapy in BC treatment strategies. Therefore, future studies need to employ larger sample sizes and incorporate a broader range of prognostic factors.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eALP\u0026thinsp;\u0026gt;\u0026thinsp;91, BC LMR\u0026thinsp;\u0026gt;\u0026thinsp;4.9 and AJCC BC Stage \u0026gt;IIIB can significantly affect SMFS of BC patients. Pre-op Ca125\u0026thinsp;\u0026gt;\u0026thinsp;115.2, Tomita Score\u0026thinsp;\u0026gt;\u0026thinsp;7, Spinal metastases with visceral metastasis, Multiple spinal metastases, and Strategy of spinal surgery can significantly affect OS of BC patients after spinal metastases.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eThe following abbreviations are used in this manuscript:\u003c/p\u003e\n\u003cp\u003eBC\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; breast cancer\u003c/p\u003e\n\u003cp\u003eSREs\u0026nbsp;\u0026nbsp;skeletal-related events\u003c/p\u003e\n\u003cp\u003eSMFS\u0026nbsp;spinal metastases free survival;\u003c/p\u003e\n\u003cp\u003eOS\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; overall survival\u003c/p\u003e\n\u003cp\u003eTNBC\u0026nbsp;triple-negative breast cancer\u003c/p\u003e\n\u003cp\u003eER\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; estrogen receptor\u003c/p\u003e\n\u003cp\u003ePR\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; progesterone receptor\u003c/p\u003e\n\u003cp\u003eNLR \u0026nbsp;\u0026nbsp;neutrophil-to-lymphocyte ratio\u003c/p\u003e\n\u003cp\u003ePLR\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; platelet-to-lymphocyte ratio\u003c/p\u003e\n\u003cp\u003eAGR\u0026nbsp; \u0026nbsp;albumin-to-globulin ratio\u003c/p\u003e\n\u003cp\u003eLMR\u0026nbsp; \u0026nbsp;lymphocyte-to-monocyte ratio\u003c/p\u003e\n\u003cp\u003eHALP\u0026nbsp;Hemoglobin, albumin, lymphocyte and platelet counts\u003c/p\u003e\n\u003cp\u003eKPS \u0026nbsp;\u0026nbsp;Karnofsky Performance Status\u003c/p\u003e\n\u003cp\u003eTES\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; total en-bloc spondylectomy\u003c/p\u003e\n\u003cp\u003eSINS\u0026nbsp;\u0026nbsp;Spinal Instability Neoplastic Score\u003c/p\u003e\n\u003cp\u003eAJCC Union International Against cancer\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization, Formal Analysis, Software, Writing-original draft: Ming Lei. Data curation, Validation: Haimei Ren. Ming Lei and Haimei Ren contributed equally to this work. Funding acquisition, Supervision, Writing-review \u0026amp; editing: Yibin Zhou. Resources, Visualization: Di Li, All the authors have read and agreed to the published version of the manuscript. The authors did not use generative AI or AI-assisted technologies in the development of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during the current study are included in this published article and its supplementary information files.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of Affiliated Hospital of Hebei University (Approval No. HDFYLL-IIT-2025-141).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatient consent was waived due to the reason that in this research process, no private or personal identity information of the subjects will be collected, and strict measures are in place to ensure that the privacy and personal identity information of the subjects will not be disclosed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCassidy JT, Baker JF, Lenehan B. 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Spinal Cord. 2007;45(10):671\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/sj.sc.3102024\u003c/span\u003e\u003cspan address=\"10.1038/sj.sc.3102024\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-oncology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dion","sideBox":"Learn more about [Discover Oncology](https://www.springer.com/12672)","snPcode":"","submissionUrl":"","title":"Discover Oncology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Breast Cancer, spinal metastases, spinal surgery, prognostic factors, survival analysis","lastPublishedDoi":"10.21203/rs.3.rs-9213252/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9213252/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eObjectives\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe aim of this study is to identify the factors that can Influence the survival and prognosis of breast cancer (BC) patients with spinal metastases.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eWe retrospectively analyzed the clinical data and survival status of 68 BC patients with spinal metastases. All patients with spinal metastases underwent surgical treatment. We identified a range of factors that may affect the survival and prognosis. Kaplan-Meier method was used to perform univariate analysis of the factors that might affect spinal metastases free survival (SMFS) and survival after spinal metastases (OS) respectively. Cox proportional hazards model was established to extract independent prognostic factors for SMFS and OS.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe mean time of SMFS was 13.83 months (median 6, range 0\u0026ndash;66 months). The mean OS was 14.74 months (median,10.5 months; range, 1\u0026ndash;64 months). ALP\u0026thinsp;\u0026gt;\u0026thinsp;91, BC LMR\u0026thinsp;\u0026gt;\u0026thinsp;4.9, AJCC BC Stage \u0026gt;IIIB, were independent prognostic factors for SMFS. Pre-op Ca125\u0026thinsp;\u0026gt;\u0026thinsp;115.2, Tomita Score\u0026thinsp;\u0026gt;\u0026thinsp;7, Spinal metastases with visceral metastasis, Multiple spinal metastases, and Strategy of spinal surgery were independent prognostic factors for OS.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eALP\u0026thinsp;\u0026gt;\u0026thinsp;91, BC LMR\u0026thinsp;\u0026gt;\u0026thinsp;4.9 and AJCC BC Stage \u0026gt;IIIB can significantly affect SMFS of BC patients. Pre-op Ca125\u0026thinsp;\u0026gt;\u0026thinsp;115.2, Tomita Score\u0026thinsp;\u0026gt;\u0026thinsp;7, Spinal metastases with visceral metastasis, Multiple spinal metastases, and Strategy of spinal surgery can significantly affect OS of BC patients after spinal metastases.\u003c/p\u003e","manuscriptTitle":"Factors Influencing Survival and Prognosis in Patients with Spinal Metastases from Breast Cancer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-19 12:35:36","doi":"10.21203/rs.3.rs-9213252/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-05T09:06:15+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-21T01:28:32+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-15T04:32:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"135541600007477726283583828233286354564","date":"2026-04-13T22:05:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"14485124601910903656364188914921735805","date":"2026-04-13T12:26:12+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-10T09:00:57+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-10T08:49:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-09T05:56:22+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-07T20:02:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Oncology","date":"2026-04-07T16:37:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-oncology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dion","sideBox":"Learn more about [Discover Oncology](https://www.springer.com/12672)","snPcode":"","submissionUrl":"","title":"Discover Oncology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e513765f-3963-4e06-9ffe-6234935011be","owner":[],"postedDate":"April 19th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-05T09:06:15+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-05T09:10:55+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-19 12:35:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9213252","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9213252","identity":"rs-9213252","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}