Abstract
Background: The modern concept of oligometastatic (OM) state has been initially developed to describe patients with a low burden of disease and with a potential for cure with local ablative treatments. We systematically assessed the risk of death and relapse of oligometastatic (OM) cancers compared to cancers with more diffuse metastatic spread, through a meta-analysis of published data. Methods: PubMed, the Cochrane Library, and EMBASE were searched for studies reporting prognosis of patients with OM solid tumors. Risk of death and relapse were extracted and pooled to provide an adjusted hazard ratio with a 95% confidence interval (HR 95%CI). The primary outcome of the study refers to overall mortality in OM vs. polymetastatic (PM) patients. Results. Mortality and relapse associated with OM state in patients with cancer were evaluated among 104,234 participants (n=173 studies). Progression-free survival was better in patients with OM disease (hazard ratio [HR] = 0.62, 95% CI 0.57-0.68; P <.001; n=69 studies). Also, OM cancers were associated with a better overall survival (OS) (HR = 0.65, 95% CI 0.62-0.68; P<.01; n=161 studies). In colorectal (CRC), breast, non-small cell lung cancer (NSCLC) and renal cell carcinoma (RCC) the reduction in the risk of death for OM patients were 35, 38, 30 and 42%, respectively. Biliary tract and cervical cancer do not significantly better in OM stage likely for paucity of data. Conclusions. Patients with OM cancers have a significantly better prognosis than those with more widespread stage IV tumors. In OM cancer patients a personalized approach should be pursued.
Highlights
The vast majority of metastatic solid tumors are incurable, and despite the evolution of treatments, patients die because of their disease
Search strategy and inclusion criteria A comprehensive search was performed with the following terms: and and and and (“hazard ratio”) and and survival
Progression-free survival was better in patients with OM disease (HR = 0.62, 95% CI 0.57–0.68; P < .01; n = 69 studies; Figure 2)
Summary
The vast majority of metastatic solid tumors are incurable, and despite the evolution of treatments, patients die because of their disease. The modern concept of oligometastatic (OM) state was initially developed in 19951 to describe patients with a low burden of disease (e.g. 1 to 3-5 metastases) with a potential for cure with local ablative treatments. This assumption relies on the hypothesis that metastatic spread follows a hierarchical pattern in time and number of localizations.[2] In some circumstances, the 8th Tumor Node Metastasis (TNM) staging system distinguishes between patients with a single metastasis and those with multiple such metastases. Large consensus on the definition and management of OM patients is currently lacking Those cancers with a lower burden of metastatic disease have a favorable prognosis and they may be amenable of local treatment for the primary and distant tumors.
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