371 例肿瘤姑息治疗多学科会诊临床分析*

目的:分析天津医科大学肿瘤医院肿瘤姑息治疗多学科专家协作组（Multidisciplinary team ,MDT ）的工作概况,评价MDT 模式在肿瘤姑息治疗领域的作用。方法:回顾性分析2014年1 月1 日至2015年3 月31日参加本院肿瘤姑息治疗MDT 会诊的371 例患者的临床资料,总结其基本特征、MDT 决策执行情况,并对部分姑息治疗方案进行疗效评价。结果:全组患者401 例次共获得318（79%）项治疗建议,其中293 项为姑息治疗建议。MDT 为119 例疼痛患者提供了合理化镇痛方案,对95例患者提出营养治疗意见,对36例患者采取了抗焦虑抑郁药物治疗。有效随访到的374 项MDT 决策,全部执行者273 项（73%）,部分执行者49项（13%）,总体执行率86% 。执行MDT 决策的患者,在疼痛控制、营养状况改善及与抑郁相关的躯体症状缓解方面均优于未执行者（P < 0.001,P < 0.001 及P < 0.01）。 结论:肿瘤姑息治疗多学科会诊能为患者提供规范的个体化综合治疗建议,执行MDT 决策有助于改善癌症患者疼痛、营养障碍及焦虑抑郁等症状,值得进一步完善和推广。      

新辅助放化疗后直肠癌术后肺转移的多学科诊疗模式决策及结果评价

  目的  了解多学科协作（multidisciplinary team,MDT）模式下直肠癌术后肺转移治疗决策现状和结局,为加强医疗质量管理、完善MDT模式提供依据。  方法  回顾性收集2007年7月至2015年2月北京大学肿瘤医院680例接受术前新辅助治疗联合根治术的直肠癌患者临床资料,调查术后发生肺转移的患者在MDT模式下的治疗决策、执行情况和生存结局。  结果  研究纳入85例术后肺转移患者,68例采用MDT模式治疗,其中28例建议行局部根治,40例建议行姑息治疗;决策总执行率为89.7%（61/68）,未执行者均选择进一步保守治疗。局部根治的患者在直肠原发灶术后首次发生复发/转移后的3年复发/转移后生存率（survival after recurrence,SAR）高于姑息治疗患者（84.8% vs.37.6%,P < 0.001）。  结论  在MDT模式运行良好的情况下,直肠癌根治术后肺转移的治疗决策执行率较高,部分患者在该模式下有机会获得根治且预后良好;引入“患者参与”和“社会支持”将有助于构建全新MDT模式和提高医疗质量管理水平。      

一例肝细胞癌和卵巢癌双原发癌患者的MDT诊治报道

本文介绍1例初诊原发性肝癌和卵巢癌双原发癌患者的多学科团队（multidisciplinary team,MDT）诊疗过程。该患者肝脏和盆腔占位性质难以确定。第1次MDT讨论考虑盆腔占位为卵巢癌伴盆腔局部转移,但肝脏病灶性质未定,双原发肿瘤还是转移性癌？患者行肝脏病灶穿刺活检提示肝细胞癌。第2次MDT讨论认为肝脏肿瘤容易破裂出血,2个部位病灶可同时手术切除。患者同时接受肝脏肿瘤、卵巢、子宫及系膜切除术。术后病理检查示肝细胞癌和卵巢高级别浆液性癌。术后患者采用紫杉醇+卡铂方案联合贝伐珠单抗治疗。随访至今未见复发,患者生存已38个月。MDT诊疗模式有利于这种较为罕见的肝和卵巢双原发恶性肿瘤的诊断和治疗方案的确定,患者也因此获得较好生存。     

首批国家肿瘤多学科诊疗试点医院情况分析

摘 要：［目的］ 分析国家首批成功申报肿瘤多学科专家协作组（multidisciplinary team，MDT）诊疗试点单位的开展情况，了解目前肿瘤MDT服务模式的现况水平、存在问题及发展方向，为进一步推动肿瘤MDT诊疗模式提供科学依据。［方法］ 摘录227家成功申报肿瘤MDT诊疗试点单位的开展情况，包括医院属性和地理位置、开展MDT基本情况、MDT组织管理模式、专业影响力和MDT发展方向共计47个统计指标，并进行统计分析。［结果］ 成功申报MDT试点的医院以东部地区比例最高（46.3%），其中东部地区以浙江省比例最高（9.7%）。肿瘤MDT开展率为76.7%，开展比例前3位的病种为结直肠癌（55.5%）、胃癌（51.1%）、肺癌（50.7%）。71.8%的医院成立MDT组织，50.3%的医院制定MDT管理制度，21.1%的医院进行绩效考核管理。［结论］ 从首批成功申报肿瘤MDT试点医院中可见，国内肿瘤MDT诊疗模式已经获得许多医院的重视并落地执行，但存在地区发展不平衡，院际发展不平衡等问题，应以国家政策为支撑，加强地区交流，促进优势医疗资源下沉，配套激励机制，同时利用信息化技术推动国内肿瘤MDT的发展。     

沃森肿瘤智能系统与多学科团队在50例肝癌治疗方案的一致性研究

摘 要：［目的］ 比较沃森肿瘤系统（WfO）和多学科团队（MDT）在原发性肝细胞癌临床决策方案中的一致性，探讨WfO在原发性肝细胞癌中的临床应用价值。［方法］ 收集2018年4月至2020年10月河北省人民医院50例进行MDT讨论的原发性肝细胞癌患者，当WfO生成的“推荐”和“供考虑”方案中包含MDT方案，即判定为决策一致，并比较两方案的诊疗决策时间。［结果］ WfO与MDT方案总一致率为78%（39/50）（Kappa=0.731，P<0.01）。MDT平均时间（37.4±7.4） min，WfO平均时间（8.5±3.9） min，WfO时间明显低于MDT，差异具有统计学意义（P<0.05）。［结论］ WfO与MDT在原发性肝细胞癌临床决策中具有较高的一致性，WfO具有耗时短、智能化程度高、信息贮存量大、数据更新快等诸多优势，在肿瘤临床决策方面具有巨大应用潜力。     

多学科MDT诊疗模式在胶质母细胞瘤患者诊疗中的应用价值

目的:探讨多学科MDT（multidisciplinary team）诊疗模式在胶质母细胞瘤（glioblastoma multiforme,GBM）患者诊疗中的应用价值。方法:选择辽宁省肿瘤医院于2015年1月至2018年1月间253例在神经外科住院治疗的胶质母细胞瘤患者为研究对象,根据诊疗模式分为MDT组182例和非MDT组71例。比较两组患者一般信息、患者满意度、治疗前等待时间、无进展生存期（progression-free survival,PFS）及总生存期（overall survival,OS）等。结果:MDT组的患者满意度高于非MDT组,差异有统计学意义（P<0．01）;MDT组治疗前等待时间短于非MDT组,分别为（18.20±4.26）天和（21.66±3.52）天,差异有统计学意义（P<0．05）;MDT组和非MDT组无进展生存期PFS分别为10.42和9.72个月,差异无统计学意义;MDT组和非MDT组总生存期OS分别为19.11月和15.86个月,差异有统计学意义（P<0．05）。结论:多学科MDT模式为胶质母细胞瘤患者的最佳诊疗模式,缩短了治疗前等待时间,提高了患者的满意度,并一定程度上延长了患者的总生存期。     

肺癌MDT对于Ⅲ期非小细胞肺癌患者的临床决策影响及预后分析

背景与目的：Ⅲ期非小细胞肺癌（non-small cell lung cancer,NSCLC）是一组预后差异较大的疾病,根据美国国立综合癌症网络（National Comprehensive Cancer Network,NCCN）指南,对于Ⅲ期NSCLC的治疗手段应采用以多学科团队（multidisciplinary team,MDT）为中心的综合治疗,同时更加强调个体化治疗的重要性。该研究旨在进一步探讨肺癌MDT对于Ⅲ期NSCLC患者预后的影响。方法：回顾性分析入组新疆医科大学第三临床医学院2012年1月—2015年4月肺癌MDT共594例NSCLC患者,根据是否服从MDT建议治疗分为两个亚组,比较两个亚组之间的临床病理特征并采用Kaplan-Meier法比较其总生存期（overall survival,OS）、无进展生存期（progression-free survival,PFS）及无病生存期（diseasefree survival,DFS）,并绘制生存曲线;另筛选2010—2011年未开展MDT组前的198例Ⅲ期NSCLC患者定义为非MDT组,比较并分析两组间患者临床-病理分期符合度、住院时长及患者满意度等方面。结果：肺癌MDT组中以是否按MDT建议治疗划分的两亚组间中位PFS和OS差异有统计学意义,中位PFS分别为7.0和6.0个月（P＜0.05）,中位OS分别为28.0和24.0个月（P＜0.05）。两亚组间DFS差异无统计学意义（P=0.24）。经COX多因素分析显示,手术与否、是否服从MDT建议、病理学类型及分期是影响患者预后的独立危险因素（P<0.05）。MDT组的临床病理学分期符合度比非MDT组高,分别为74.24%和65.22%（P＜0.05）。MDT组的患者平均满意度高于非MDT组,分别为2.68和2.01（P＜0.05）,但两组住院时长无明显差异。结论：Ⅲ期NSCLC患者的最佳诊疗模式为MDT。     

肺癌多学科会诊在二级医院的现状调查

目的:了解二级医院从事肺癌相关工作的医生对肺癌相关知识的掌握和对肺癌多学科会诊（multidisciplinary team,MDT）认知度的现状,分析二级医院不能严格实行肺癌MDT制度的原因。方法:采用便利抽样法,对重庆市某些二级医院从事肺癌相关工作的129名医生的肺癌专科知识和肺癌多学科会诊认知度进行调查。结果:医生肺癌专业知识得分优秀和良好0人,一般26人（20.2%）,差103人（79.8%）;从事肺癌相关工作的医生对肺癌MDT态度得分30.52±5.12,其中持正性态度30人（23.3%）,持中性态度81人（62.8%）,持负性态度18人（14.0%）;医生肺癌相关知识与肺癌MDT认识度呈正相关。结论:二级医院中从事肺癌相关工作的医生对肺癌相关知识有待提高,医生对肺癌MDT认知度差,导致肺癌MDT难以实施的原因有学科带头人的缺乏、医疗体制的弊端、MDT制度的落后等。     

34例子宫内膜癌合并结直肠癌双原发癌的临床特征及其与Lynch 综合征关系分析

目的:探讨子宫内膜癌合并结直肠癌双原发癌患者的临床表现、治疗方法及其预后,并分析与Lynch 综合征关系。方法:回顾性分析中国医学科学院肿瘤医院34例子宫内膜癌合并结直肠癌双原发癌患者的临床病理资料。结果:34例患者的中位发病年龄为51.5（39~ 76）岁,64.7%（22/ 34）有肿瘤家族史,子宫内膜样腺癌占79.4%（27/ 34）。 34例中33例双原发癌患者行手术治疗,19例子宫内膜癌、17例结直肠癌术后行放化疗。2 年生存率为84.3% ,5 年生存率为63.1% 。结论:子宫内膜癌合并结直肠癌双原发癌患者多具有肿瘤家族史、发病年龄早、预后与散发型结直肠癌相近,部分患者符合Lynch 综合征。      

中国Ⅳ期原发性肺癌多学科团队诊疗实施指南

Ⅳ期原发性肺癌患者虽然有多种治疗选择, 但由于病情复杂, 疾病异质性较大, 在诊疗过程中出现的问题可能会涉及全身多个系统和器官, 因此, 在临床实践过程中经常需要不同学科之间相互协作。多学科团队(MDT)是指由来自两个以上的相关学科, 组成固定的工作组, 针对某一疾病的特定患者, 通过会诊形式, 提出适合患者的最佳个体化治疗方案, 并由相关学科单独或多个学科联合执行该治疗方案。MDT是一种广为推崇的诊疗模式, 特别适用于肿瘤患者, 已经成为国际上恶性肿瘤诊疗的基本原则, Ⅳ期原发性肺癌的诊疗也遵循MDT原则。为了促进中国Ⅳ期原发性肺癌MDT模式的健康发展和Ⅳ期原发性肺癌诊疗水平的提高, 中国医师协会肿瘤医师分会和中国医疗保健国际交流促进会肿瘤内科分会共同组织全国专家编写了中国Ⅳ期原发性肺癌多学科团队诊疗实施指南, 供临床医师参考。     

Multidisciplinary decisions in breast cancer: does the patient receive what the team has recommended?

Background:

A multidisciplinary team (MDT) approach to breast cancer management is the gold standard. The aim is to evaluate MDT decision making in a modern breast unit.

Methods:

All referrals to the breast MDT where breast cancer was diagnosed from 1 July 2009 to 30 June 2011 were included. Multidisciplinary team decisions were compared with subsequent patient management and classified as concordant or discordant.

Results:

Over the study period, there were 3230 MDT decisions relating to 705 patients. Overall, 91.5% (2956 out of 3230) of decisions were concordant, 4.5% (146 out of 3230), were discordant and 4% (128 out of 3230) had no MDT decision. Of 146 discordant decisions, 26 (17.8%) were considered ‘unjustifiable'' as there was no additional information available after the MDT to account for the change in management. The remaining 120 discordant MDT decisions were considered ‘justifiable'', as management was altered due to patient choice (n=61), additional information available after MDT (n=54) or MDT error (n=5).

Conclusion:

The vast majority of MDT decisions are implemented. Management alteration was most often due to patient choice or additional information available after the MDT. A minority of management alterations were ‘unjustifiable'' and the authors recommend that any patient whose treatment is subsequently changed should have MDT rediscussion prior to treatment.     

China special issue on gastrointestinal tumors-Improved survival after multidisciplinary team decision for patients with advanced gastrointestinal cancer: A multicenter,noninterventional, controlled study

Formal multidisciplinary team (MDT) discussions in clinical practice require time and space but have unclear survival benefits for advanced gastrointestinal cancer patients. Our study aimed to investigate the long-term survival of patients with advanced gastrointestinal cancer after MDT decision. From June 2017 to June 2019, continuous MDT discussions on advanced gastrointestinal cancer were conducted in 13 medical centers in China. MDT decisions and actual treatment received by patients were prospectively recorded. The primary endpoint was the difference in overall survival (OS) between patients in the MDT decision implementation and nonimplementation groups. The secondary endpoints included the implementation rate of MDT decisions and subgroup survival analysis. A total of 461 MDT decisions of 455 patients were included in our study. The implementation rate of MDT decisions was 85.7%. Previous treatment had an impact on MDT decision-making. The OS was 24.0 months and 17.0 months in the implementation and nonimplementation groups, respectively. The implementation of MDT decisions significantly reduced the risk of death in multivariate analyses (hazard ratio = 0.518; 95% confidence interval: 0.304-0.884, P = .016). Subgroup analysis showed a significant difference in survival of patients with colorectal cancer, but not in survival of patients with gastric cancer. The rate of secondary MDT discussion was only 5.6% among patients who the MDT decisions were discontinued due to changes in their condition. MDT discussion can prolong the OS of patients with advanced gastrointestinal cancer, especially those with colorectal cancer. Timely scheduling of the subsequent MDT discussion is necessary when the disease condition changes.     

MRI directed multidisciplinary team preoperative treatment strategy: the way to eliminate positive circumferential margins?

Histopathological audit of positive circumferential resection margins (CRMs) can be used as a surrogate measure of the success of rectal cancer treatment. We audited CRM involvement in rectal cancer patients and the impact of the multidisciplinary team (MDT) on implementing a magnetic resonance imaging (MRI)-based preoperative treatment strategy. Data were collected on all newly diagnosed rectal cancer patients treated in our network between January 1999 and December 2002. Data were analysed for MRI prediction and histopathological assessment of CRM together with the MDT meeting treatment decisions. The CRM+ve rate of those discussed at MDT vs those not discussed were compared. We re-audited the CRM+ve rates 1 year after introducing a policy of mandatory preoperative MRI-based MDT discussion. Of the 298 patients diagnosed with rectal cancer, 39 (13%) were deemed palliative, 178 underwent surgery alone and 81 underwent neoadjuvant therapy. Of these, 62 out of 178 patients underwent surgery alone without MRI-based MDT discussion resulting in positive CRM in 16 cases (26%) as compared to 1 out of 116 (1%) in those patients with MDT discussion of MRI. Overall CRM+ve rate in all nonpalliative patients with or without MDT discussion was 12.5% (32 out of 256), significantly lower than the <20% rate (P<0.001) quoted in national guidelines. Re-audit in 98 consecutive patients following a change of policy produced a lower CRM+ve rate of 3% (1 out of 37) for all surgery alone patients and an overall CRM+ve rate of 7% (5 out of 70). In conclusion, MDT discussion of MRI and implementation of a preoperative treatment strategy results in significantly reduced positive CRM in rectal cancer patients.     

Do multidisciplinary team meetings make a difference in the management of lung cancer?

BACKGROUND:

There is limited evidence regarding the effectiveness of multidisciplinary team (MDT) meetings in lung cancer. The objective of this study was to compare the patterns of care for patients with newly diagnosed lung cancer who were presented at a lung cancer MDT meeting with the patterns of care for patients who were not presented.

METHODS:

All patients who had lung cancer newly diagnosed in South West Sydney (SWS) between December 1, 2005, and December 31, 2008, were identified from the local Clinical Cancer Registry. Patient and tumor characteristics and treatment receipt were compared between patients who were and were not presented at MDT meetings. A logistic regression model was constructed to determine predictors for receiving treatment and survival.

RESULTS:

In total, there were 988 patients, including 504 patients who were presented at MDT meetings and 484 who were not presented at MDT meetings. The median patient age was 69 years and 73 years in the MDT group and the non‐MDT group, respectively (P < .01). There was no pathologic diagnosis for 13% of non‐MDT patients compared with 4% of MDT patients (P < .01). Treatment receipt for MDT patients versus non‐MDT patients was 12% versus 13%, respectively, for surgery (P value nonsignificant); 66% versus 33%, respectively, for radiotherapy (P < .001); 46% versus 29%, respectively, for chemotherapy (P < .001); and 66% versus 53%, respectively, for palliative care (P < .001). In patients with good performance status, the MDT group had significantly better receipt of radiotherapy among patients with stage I through IV nonsmall cell lung cancer (NSCLC) and had significantly better receipt of chemotherapy among patients with stage IV NSCLC. MDT discussion was an independent predictor of receiving radiotherapy, chemotherapy, and referral to palliative care but did not influence survival.

CONCLUSIONS:

MDT discussion was associated with better treatment receipt, which potentially may improve quality of life for patients with lung cancer. However, it did not improve survival. Cancer 2011;. © 2011 American Cancer Society.     

Analysis of clinical decision-making in multi-disciplinary cancer teams.

Management decisions for patients with cancer are frequently taken within the context of a multi-disciplinary team (MDT). There is little known, however, about decision-making at team meetings and whether MDT decisions are all implemented. This study evaluated team decision-making in upper gastrointestinal cancer. Consecutive MDT treatment decisions were recorded for patients with oesophageal, gastric, pancreatic and peri-ampullary tumours. Implementation of MDT decisions was investigated by examining hospital records. Where decisions were implemented it was recorded as concordant and discordant if the decision changed. Reasons for changes in MDT decisions were identified. 273 decisions were studied and 41 (15.1%) were discordant (not implemented), (95% confidence interval 11.1-20.0%). Looking at the reasons for discordance, 18 (43.9%) were due to co-morbid health issues, 14 (34.2%) related to patient choice and 8 (19.5%) decisions changed when more clinical information was available. For one discordant decision, the reason was not apparent. Discordant decisions were more frequent for patients with pancreatic or gastric carcinoma as compared to oesophageal cancer (P = 0.001). Results show that monitoring concordance between MDT decisions and final treatment implementation is useful to inform team decision-making. For upper gastrointestinal cancer, MDTs require more information about co morbid disease and patient choice to truly optimize the implementation of multi-disciplinary expertise.     

The Prognostic Effect of Multidisciplinary Team Intervention in Patients with Advanced Gastric Cancer

Background: The effect of multidisciplinary team intervention (MDT) on the prognosis of advanced gastric cancer (GC) is still controversial. This study aims to analyze the effect of MDTs on the overall survival time of advanced gastric cancer patients. Methods: Patients with advanced GC who underwent surgical treatment between 2007 and 2014 were included in the study. They were divided into two groups; the MDT group received MDT treatment and the non-MDT group received conventional treatment. The Kaplan-Meier method was used to compare the overall survival (OS) of the two groups. The prognostic factors of advanced GC were evaluated by multivariate Cox regression analysis. Results: 394 patients were included in our study. Kaplan-Meier survival analysis showed that the prognosis of advanced GC patients with who underwent MDT intervention was better than those without (3-year OS of 55.6% vs. 46.1%, p = 0.005), Multivariate analysis indicated that MDT intervention could reduce mortality (HR = 0.493, p < 0.001). Conclusions: MDT intervention is an effective measure that improves the survival of patients with advanced GC.     

恶性肿瘤多学科综合诊疗模式的探索

多学科专家协作组(multidisciplinary team,MDT)诊疗模式已经成为恶性肿瘤诊疗的国际趋势.中国医学科学院肿瘤医院从2000年开始探索,开展针对住院患者和门诊患者的多种形式的MDT诊疗模式,出台了相应的规范制度和激励机制,对MDT诊疗工作的开展起到了积极作用.MDT诊疗模式的发展和壮大,加强了学科间的协作,提高了医疗质量,保障了患者的治疗效果.