Cancer Res Treat.  2022 Oct;54(4):953-969. 10.4143/crt.2022.329.

Role of Local Treatment for Oligometastasis: A Comparability-Based Meta-Analysis

• Rim CH
• Cho WK
• Lee JH
• Kim YS
• Suh YG
• Kim KH
• Chie EK
• Ahn YC
• The Oligometastasis Working Group, Korea Cancer Association

• KMID: 2534176
• DOI: http://doi.org/10.4143/crt.2022.329

Abstract

Purpose
We intend to investigate the oncological efficacy and feasibility of local consolidative therapy (LCT) through a meta-analysis method.
Materials and Methods
Four databases including PubMed, MEDLINE, Embase, and Cochrane library were searched. Target studies are controlled trials comparing outcomes of LCT versus a control group. Primary endpoints are overall survival (OS) and progression-free survival (PFS).
Results
A total of 54 studies involving 7,242 patients were included. Pooled analyses showed that the LCT arm could achieve improved OS with pooled odds ratio of 2.896 (95% confidence interval [CI], 2.377 to 3.528; p < 0.001). Regarding PFS, pooled analyses showed pooled odds ratio of 3.045 (95% CI, 2.356 to 3.937; p < 0.001) in favor of the LCT arm. In the subgroup analyses including the studies with reliable comparability (e.g. randomized studies or intentionally matched studies without significant favorable prognosticator in LCT arms), pooled odds ratio was 2.548 (95% CI, 1.808 to 3.591; p < 0.001) favoring the LCT arm regarding OS. Regarding PFS, pooled OR was 2.656 (95% CI, 1.713 to 4.120; p < 0.001) which also favored the LCT arm. Subgroup analyses limited to the randomized controlled trials (RCT) were also performed and pooled odds ratios on OS and PFS were 1.535 (95% CI, 1.082 to 2.177; p=0.016) and 1.668 (95% CI, 1.187 to 2.344; p=0.003). The rates of grade ≥ 3 complications related to LCT was mostly low (< 10%) and not significantly higher compared to the control arm.
Conclusion
Pooled analyses results of all included studies, selected studies with reliable comparability, and RCT’s demonstrated the survival benefit of LCT. These consistent results suggest that LCT was beneficial to the patients with oligometastasis.

Keyword

Oligometastasis; Local therapy; Radiotherapy; Surgery; Meta-analysis

Figure

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  Fig. 1 Study inclusion plot. NCDB, National Cancer Database.

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  Fig. 2 Descriptive summary of definition of oligometastases among included studies (A), modality of local consolidative therapy used in included studies (B), and number of studies included according to site of origin (C). HCC, hepatocellular carcinoma; H&N, head and neck; NSCLC, non-small cell lung cancer; RCC, renal cell carcinoma; SCLC, small cell lung cancer.

• 

  Fig. 3 Forest plots of pooled analyses regarding overall survival, including all studies (A), studies with reliable comparability (B), and randomized controlled trials (C) [7,8,21–31,34,35,37–45,47–53,55–66,68–71,73]. BDC, biliary duct cancer; HCC, hepatocellular carcinoma; H&N, head and neck; LCT, local consolidative therapy; NSCLC, non-small cell lung cancer; RCC, renal cell carcinoma; SCLC, small cell lung cancer; 2yCSS, 2-year cancer-specific survival; 5yCSS, 5-year cancer-specific survival.

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  Fig. 4 Forest plots of pooled analyses regarding progression-free survival, including all studies (A), studies with reliable comparability (B), and randomized controlled trials (C) [6–8,20–22,25–28,31–33,35,36,38,39,42,43,46–48,50,52–54,56,58–60,62–64,66,67,69–71,73]. HCC, hepatocellular carcinoma; H&N, head and neck; LCT, local consolidative therapy; NSCLC, non-small cell lung cancer; RCC, renal cell carcinoma; SCLC, small cell lung cancer; 5ySSFS, 5-year second-line systemic therapy free survival.

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  Fig. 5 Pooled survival percentile of overall survival (A) and progression-free survival (B) according to site of origin. HCC, hepatocellular carcinoma; H&N, head and neck; LCT, local consolidative therapy; NSCLC, non-small cell lung cancer; SCLC, small cell lung cancer.

Reference

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