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近期，Lancet Oncol发表了由EORTC（欧洲癌症治疗研究组织）与ESTRO（欧洲放射治疗与肿瘤学会）牵头的关于寡转移特征变量及分类系统的专家共识！共有20名该领域专家参与制定。
三步骤：系统回顾以收集变量3 Delphi rounds以形成特征变量统一 3 Delphi rounds以形成分类系统
01PART系统回顾在PubMed and Embase 检索关于寡转移前瞻性临床试验，检索策略： ([“oligometastasis” OR “oligometastatic” OR “oligometastases” OR “oligorecurrence” OR “oligo recurrent” OR “oligoprogression” OR “oligoprogressive” OR “oligopersistent” OR “oligopersistence”] AND [“randomised” OR “randomized” OR “prospective”])
完成检索后，26篇文献通过提取其中的inclusion与exclusion条件作为特征变量库，随后进行共识形成；
02PART3 Delphi rounds形成特征变量共识1st round：通过网络咨询形式（SurveyMonkey and Google Forms），向专家反馈上述收集的特征变量，最后再加上一条开放性的题目“to describe potential oligometastatic disease characterisation factors and classification factors that had not been identified in the systematic review”2nd round：研究者将第一轮的意见综合后将结果匿名进一步反馈，并进行核实；3rd round：通过收集前两轮的特征变量，由专家对每一变量进行评分，1-5分（1=strongly agree; 5=strongly disagree）；只有达到75%以上一致意见的变量才纳入最终panel；同时分析并收集未能达到一致的相关变量，再次进行投票，已确保最终特征变量panel的规范统一；
最终形成的关于寡转移的特征变量panel如下：
建议对寡转移患者进行治疗前，都必须进行以上变量的肿瘤评估！
03PART寡转移分类通过上述的寡转移特征变量，研究组进一步通过三轮Delphi形成寡转移分类共识，结果如下：
Question 1: Does the patient have a history of polymetastatic disease before current diagnosis of oligometastatic disease?Question 2: Does the patient have a history of oligometastatic disease before the current diagnosis of oligometastatic disease?Question 3: Has oligometastatic disease been first diagnosed more than 6 months after the primary cancer diagnosis?Question 4: Is the patient under active systemic therapy at the time of oligometastatic disease diagnosis?Question 5: Are any oligometastatic lesions progressive on current imaging?
Induced oligometastatic disease ：表示既往有polymetastatic病史Genuine oligometastatic disease：表示既往无polymetastatic病史，其可进一步分为 repeat oligometastatic disease（既往有寡转移病史）与de-novo oligometastatic disease（首次诊断为寡转移）；其中de-novo oligometastatic disease根据timeline可分为synchronous与metachronous；另外，亚分类中的oligorecurrence代表发生在无治疗间隔期；oligoprogression代表发生在全身治疗期间；而oligopersistence代表目前寡转移病灶无进展；
此外，文章还强调患者的寡转移状态是可以相关转变的，如下图：
OligoCare：前瞻性观察性临床试验文章内多次提及，这次所提出的变量及分类系统有待OligoCare临床试验（NCT03818503）中验证其在临床实践中的作用以及其预后相关性；以下相关内容来自clinical trial网站上关于该临床试验相关信息：Brief Summary:The primary objective is the collection of real-world data of cancer patients treated with radiotherapy, to support radiotherapy research and to provide evidence of the role of radiation oncology in a multidisciplinary approach. This is an open ended prospective non-interventional non-therapeutic multi-cohort study.
欧洲的寡病灶共识.pdf
(2.1 MB)
Guckenberger M, Lievens Y, Bouma AB, Collette L, Dekker A, deSouza NM, Dingemans AC, Fournier B, Hurkmans C, Lecouvet FE, Meattini I, Méndez Romero A, Ricardi U, Russell NS, Schanne DH, Scorsetti M, Tombal B, Verellen D, Verfaillie C, Ost P. Characterisation and classification of oligometastatic disease: a European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer consensus recommendation. Lancet Oncol. 2020 Jan;21(1):e18-e28. doi: 10.1016/S1470-2045(19)30718-1. PMID: 31908301.
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