Machine learning of genomic features in organotropic metastases stratifies progression risk of primary tumors

Abstract Metastasis leads to most cancer deaths, but its spatiotemporal behavior remains unpredictable at early stage. Here, we developed MetaNet, a computational framework that integrates clinical and sequencing data from 32,176 primary and metastatic cancer cases, to assess metastatic risks of primary tumors. MetaNet achieved high accuracy in distinguishing the metastasis from the primary in breast and prostate cancers. From the prediction, we identified Metastasis-Featuring Primary (MFP) tumors, a subset of primary tumors with genomic features enriched in metastasis, and demonstrated their high metastatic risks with significantly shorter disease-free survivals and higher migratory potential. In addition, we identified genomic alterations associated with organ-specific metastases, and employed them to stratify patients into the risk groups with propensities toward different metastatic organs. Remarkably, this organotropic stratification achieved better prognostic value than standard histological grading system in prostate cancer, especially between Bone-MFP and Liver-MFP subtypes, with organotropic insights to inform organ-specific examinations in follow-ups.