Molecular Tumor Boards clinical impact on patient care and structural features: A systematic review and meta-analysis

BACKGROUND: Molecular Tumor Boards (MTBs) bring together multidisciplinary experts to translate genomic data into clinical decisions in oncology, however, their overall clinical impact remains unclear. The aim of this systematic review is to assess the clinical impact of MTB-recommended therapies on patients with cancer outcomes. METHODS AND FINDINGS: In this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, and CENTRAL up to July 2025. We included studies of any design, both single-arm studies and studies with a comparator group, that reported the clinical impact of MTBs in patients who received MTB-guided therapy. Meta-analyses were performed separately by study design, using hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS), relative risks (RRs) for objective response rate (ORR) and disease control rate (DCR), and pooled proportions for PFS ratio ≥1.3. All meta-analyses were conducted using random-effects models based on the inverse variance method. We evaluated the risk of bias using the RoB 2.0 for RCTs and ROBINS-I for non-randomized studies. From 6,846 records, 78 studies (9,195 patients; 4,569 treated per MTB recommendations) were included. MTB-guided therapies were associated with reduced risk of death (HR 0.87; 95% CI [0.76, 1.01]; p = 0.069; I2 = 0.0% in RCTs; 0.62 in retrospective studies) and disease progression (HR 0.73; 95% CI [0.64, 0.84]; p < 0.001; I2 = 0.0% in RCTs; 0.63 in retrospective studies), as well as improved ORR (RR 1.75; 95% CI [1.24, 2.47]; p = 0.001; I2 = 0.0% in RCTs; 3.32 in retrospective studies) and DCR (RR 1.20; 95% CI [1.03, 1.40]; p = 0.018; I2 = 19.9% in RCTs; 1.65 in retrospective studies). Between 33% and 43% of patients achieved a PFS ratio ≥1.3. While the risk of bias for RCTs was low, except for one study that was rated as having some concerns, the overall risk of bias for non-randomized studies was rated as "serious" in most of the studies (n = 54). Limitations include substantial heterogeneity, predominance of non-randomized studies with risk of bias, and limitations in data reporting, which restrict causal inference. CONCLUSIONS: This meta-analysis provides robust evidence from RCTs supporting the clinical benefit of MTBs, although limited for OS. Methodological heterogeneity and study limitations from observational studies warrant cautious interpretation. Future high-quality RCTs and standardized reporting are needed to confirm these findings and guide the integration of MTBs into routine clinical practice and health system strategies.