Better survival of patients with oligo- compared with polymetastatic cancers: a systematic review and meta-analysis of 173 studies

Fausto Petrelli, Antonio Ghidini, Michele Ghidini, Roberta Bukovec, Francesca Trevisan, Luca Turati, Alice Indini, Silvia Seghezzi, Veronica Lonati, Giovanna Moleri, Gianluca Tomasello, Alberto Zaniboni, Fausto Petrelli, Antonio Ghidini, Michele Ghidini, Roberta Bukovec, Francesca Trevisan, Luca Turati, Alice Indini, Silvia Seghezzi, Veronica Lonati, Giovanna Moleri, Gianluca Tomasello, Alberto Zaniboni

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.

Trial registration: ClinicalTrials.gov NCT02364557 NCT04115007 NCT04248452.

Keywords: cancer; meta-analysis; oligometastases; review; survival; tumours.

Conflict of interest statement

No competing interests were disclosed.

Copyright: © 2022 Petrelli F et al.

Figures

Figure 1.. Preferred Reporting Items for Systematic…
Figure 1.. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 flow diagram showing the process of study inclusion.
Figure 2.. Progression-free survival of oligo- compared…
Figure 2.. Progression-free survival of oligo- compared to non-oligometastatic cancers.
Figure 3.. Overall survival of oligo- compared…
Figure 3.. Overall survival of oligo- compared to non-oligometastatic cancers.
Figure 4.. Funnel plot of publication bias…
Figure 4.. Funnel plot of publication bias for overall survival analysis showing standard error by log hazard ratio.

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