A stochastic model of metastatic bottleneck predicts patient outcome and therapy response

Metastases are responsible for 90% of cancer-related deaths. Initiation of metastases, where newly seeded tumor cells expand into colonies, presents a tremendous bottleneck to metastasis formation. Despite its clinical importance, our understanding of this process is very limited. Here, we propose a simple stochastic model assuming that the initiating metastatic cells proliferate faster when surrounded by more of their kind. The model quantifies the severity of metastatic bottleneck as the probability that the seeded colony survives. Based on this model, we derive how metastasis occurrence depends on primary tumor size and affects patient outcome. Our predictions agree with epidemiological data for thirteen cancer types. The model predicts that impact of treatment decisions depends both on the primary tumor size and on the severity of the metastatic bottleneck, and that medical interventions that tighten the bottleneck would be much more efficient than therapies that decrease overall tumor burden, such as chemotherapy.