Gofrit Ofer N, Gofrit Ben, Roditi Yuval, Popovtzer Aron, Frank Steve, Sosna Jacob, Goldberg S Nahum
Department of Urology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, 12000, 91120, Jerusalem, Israel.
School of Engineering and Computer Science, Hebrew University of Jerusalem, Jerusalem, Israel.
Discov Oncol. 2023 Feb 6;14(1):19. doi: 10.1007/s12672-023-00625-2.
Oligometastatic disease (OD) is usually defined arbitrarily as a condition in which there are ≤ 5 metastases. Given limited disease, it is expected that patients with OD should have better prognosis compared to other metastatic patients and that they can potentially benefit from metastasis-directed therapy (MDT). In this study, we attempted to redefine OD based upon objective evidence that fulfill these assumptions.
Chest CTSs of 773 patients with 15,947 lung metastases originating from ten malignancy types were evaluated. The number and largest diameter of each metastasis was recorded. Metastatic cluster was defined as a cluster of two or more metastases with diameter difference ≤ 1 mm. The prognostic power of seven statistical models on overall survival (OS) was analyzed.
Both the number of metastases and metastatic clusters had a highly significant impact on OS (p < 0.0001, p = 0.003 respectively). Patients with a single metastasis or a single cluster of metastases (regardless of metastases number), equaling 16.2% of all patients, had significantly better prognosis compared to other patients (p = 0.0002). If metastases diameter variability is ignored, as in the standard definition of OD, then patients with 2-5 and 6-10 metastases would have a similar prognosis.
Patients with a single cluster of metastases, theoretically originating from a single clone, have significantly better prognosis compared to patients with more than one cluster. Using this definition can potentially improve the results of MDT. The upper limit of metastases number should be determined by the technical capabilities of the MDT used.
寡转移疾病（OD）通常被任意定义为转移灶≤5个的一种情况。鉴于疾病范围有限，预计OD患者与其他转移患者相比预后应更好，并且他们可能从转移灶定向治疗（MDT）中获益。在本研究中，我们试图基于满足这些假设的客观证据对OD进行重新定义。
对773例源自十种恶性肿瘤类型的15947个肺转移灶患者的胸部CT进行评估。记录每个转移灶的数量和最大直径。转移灶簇被定义为两个或更多直径差异≤1mm的转移灶簇。分析了七种统计模型对总生存期（OS）的预后预测能力。
转移灶数量和转移灶簇均对OS有高度显著影响（分别为p<0.0001，p = 0.003）。单个转移灶或单个转移灶簇（无论转移灶数量）的患者占所有患者的16.2%，其预后明显优于其他患者（p = 0.0002）。如果像OD的标准定义那样忽略转移灶直径变异性，那么有2 - 5个和6 - 10个转移灶的患者预后将相似。
理论上源自单个克隆的单个转移灶簇患者的预后明显优于有多个转移灶簇的患者。采用这一定义可能会改善MDT的效果。转移灶数量的上限应由所用MDT的技术能力决定。
