Meta-analysis shows local consolidative therapy plus systemic therapy improves survival in driver-negative oligometastatic NSCLC.

Oligometastatic non-small cell lung cancer (NSCLC) represents a potentially modifiable stage of metastatic disease, however, the survival benefit of local consolidative therapy (LCT) in patients without actionable driver mutations remains uncertain in the era of immunotherapy. To address this clinically relevant controversy, we performed a systematic review and meta-analysis evaluating the efficacy and safety of adding LCT to systemic therapy in driver-negative oligometastatic NSCLC. A comprehensive search of PubMed, Embase, and the Cochrane Library through December 2025 identified 13 eligible studies including 1,698 patients. Pooled analyses demonstrated that the addition of LCT was significantly associated with improved overall survival (HR 0.45, 95% CI 0.36-0.56) and progression-free survival (HR 0.53, 95% CI 0.46-0.61) compared with systemic therapy alone. Notably, cumulative meta-analysis showed that the survival advantage remained stable as evidence accrued over time, underscoring the consistency of the treatment effect. LCT was also associated with a higher objective response rate (RR 1.47, 95% CI 1.12-1.93) without a significant increase in treatment-related adverse events (RR 1.31, 95% CI 0.93-1.84). Importantly, subgroup analyses demonstrated that the survival benefit persisted in studies incorporating immunotherapy-based regimens, suggesting that LCT retains clinical value even within contemporary systemic treatment paradigms. Sensitivity analyses confirmed the robustness of these findings, and no significant publication bias was detected. Collectively, these results indicate that integrating LCT into systemic therapy is associated with meaningful survival gains in driver-negative oligometastatic NSCLC without added toxicity, supporting a risk-adapted, multidisciplinary treatment strategy in the modern immunotherapy era.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier CRD420261351878.