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Cancer-specific survival patterns in patients with bone metastasis: a registry-based analysis of 13,742 patients
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  • Published: 19 March 2026

Cancer-specific survival patterns in patients with bone metastasis: a registry-based analysis of 13,742 patients

  • Zelin Yun1 na1,
  • Yanchao Tang1 na1,
  • Jie Sun2,3 na1,
  • Juncai Lei1,
  • Gangqiang Zhang1,
  • Feng Wei1 &
  • …
  • Xiaoguang Liu1,4 

Scientific Reports , Article number:  (2026) Cite this article

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We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Subjects

  • Biomarkers
  • Cancer
  • Oncology

Abstract

With increasing opportunities for patients with bone metastasis (BM) to benefit from local surgical intervention, accurate survival analysis across different primary cancers remains challenging. Current analytical frameworks commonly rely on single-center, pan-cancer cohorts and provide insufficient integration of cancer-specific characteristics. In this retrospective, multicenter, registry-based cohort study, baseline demographic and clinical characteristics of 13,742 patients with AJCC stage IV or TNM stage M1 metastatic cancer were collected from 42 studies registered in the cBioPortal for Cancer Genomics database. Overall survival (OS) after metastatic diagnosis was the primary outcome. Univariate analyses were performed using Kaplan–Meier methods, log-rank tests, and non-parametric tests. Variables with p < 0.20 were included in multivariable Cox proportional hazards models to examine independent associations with survival. Multiple imputation was applied to address missing data. Among the 25 primary cancers analyzed, approximately half showed observable survival differences between BM and other-site metastasis, with 6 cancers reaching statistical significance. Based on median survival, all cancers could be stratified into 3 distinct survival tiers, ranging from prolonged survival exceeding 15 months to markedly shorter survival of 3–10 months, with multivariable analyses further demonstrating that primary cancer type was the strongest factor associated with survival heterogeneity among BM patients (HR = 1.422–1.758, p < 0.001). Moreover, poorly differentiated or undifferentiated histology was independently associated with worse OS (HR = 1.249, p < 0.001), and age > 60 years was also associated with shorter survival (p < 0.001). No single metastatic site demonstrated a consistent adverse association with survival across cancer types. Overall, BM demonstrates cancer-specific and heterogeneous associations with survival compared with other metastatic sites. All primary cancers could be stratified into 3 groups, representing the most important factor associated with survival differences. Moreover, pathological differentiation was significantly associated with survival among BM patients. Notably, no metastatic site functions as a universal prognostic factor across cancers. Large-scale, multicenter, registry-based analyses provide a valuable framework for cancer-specific survival analysis and for identifying clinically relevant factors that may serve as a reference for risk stratification in surgical decision-making.

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Data availability

The datasets supporting the conclusions of this study are available from the corresponding author on reasonable request or can be accessed from the cBioPortal for Cancer Genomics (https://www.cbioportal.org/).

Abbreviations

AJCC:

American Joint Committee on Cancer

BM:

Bone metastasis

BMI:

Body mass index

CI:

Confidence interval

CV:

Coefficient of variation

EGFR:

Epidermal growth factor receptor

EMT:

Epithelial–mesenchymal transition

ECOG:

Eastern Cooperative Oncology Group

HF:

Hazard ratio

IHC:

Immunohistochemistry

IQR:

Interquartile range

K–S:

Kolmogorov–Smirnov

MAXSTAT:

Maximally selected rank statistics

NSCLC:

Non-small cell lung cancer

OBM:

Only bone metastasis

OS:

Overall survival

OSM:

Other-site metastasis

PH:

Proportional hazards

PS:

Probability of superiority

RECORD:

Reporting of studies conducted using observational routinely-collected health data

STROBE:

Strengthening the reporting of observational studies in epidemiology

TNM:

Tumor–node–metastasis

VIF:

Variance inflation factor

WFNS:

World federation of neurosurgical societies

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Acknowledgements

We sincerely thank Prof. Wei and Prof. Liu for their valuable guidance on integrating this project with clinical practice. The authors gratefully acknowledge Peking University Third Hospital and the National Natural Science Foundation of China for hardware support in data processing and financial funding for the overall implementation of this project.

Funding

This study was supported by the Peking University Third Hospital (Grant No. BYSYZD2023017) and the National Natural Science Foundation of China (Grant Nos. 82201644 and 82471505). The funding bodies had no role in the design of the study, data collection, analysis, interpretation of data, or in writing the manuscript.

Author information

Author notes

  1. Zelin Yun, Yanchao Tang and Jie Sun contributed equally to this study.

Authors and Affiliations

  1. Department of Orthopaedics, Peking University Third Hospital, Beijing, 100191, China

    Zelin Yun, Yanchao Tang, Juncai Lei, Gangqiang Zhang, Feng Wei & Xiaoguang Liu

  2. Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA

    Jie Sun

  3. Pain Medicine Center, Peking University Third Hospital, Beijing, 100191, China

    Jie Sun

  4. Beijing Key Laboratory of Advanced Bioadaptable Orthopedic Implants, Beijing, China

    Xiaoguang Liu

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  4. Juncai Lei
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  5. Gangqiang Zhang
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  6. Feng Wei
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  7. Xiaoguang Liu
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Contributions

Z.L. Yun, Y.C. Tang, and J. Sun conceived and designed the study. Z.L. Yun, J.C. Lei, and G.Q. Zhang collected the data. Z.L. Yun and Y.C. Tang performed the statistical analysis. Z.L. Yun drafted the manuscript. F. Wei and X.G. Liu supervised the study and were responsible for manuscript revision and correspondence. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Feng Wei or Xiaoguang Liu.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

The study is retrospective and registry-based without clinical or experimental intervention, and the data used were collected from a public database. For these reasons, informed consent was applied for exemption. The study was conducted with the support of Peking University Third Hospital. Ethical approval was granted by the Research Ethics Committee (approval number: LM2025366).

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Yun, Z., Tang, Y., Sun, J. et al. Cancer-specific survival patterns in patients with bone metastasis: a registry-based analysis of 13,742 patients. Sci Rep (2026). https://doi.org/10.1038/s41598-026-43780-6

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  • Received: 17 December 2025

  • Accepted: 06 March 2026

  • Published: 19 March 2026

  • DOI: https://doi.org/10.1038/s41598-026-43780-6

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Keywords

  • Bone metastasis
  • Survival
  • Registry-based
  • Multicenter
  • Cancer-specific
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