多学科专家组诊疗模式在结直肠癌诊疗中的作用

目的：当今诊治结直肠癌的各个学科快速持续发展的发展，单靠一个学科很难使患者获得最佳治疗方案，多学科专家组诊疗模式对结直肠癌的诊治在欧美国家被推荐应用甚至定为法规，而在中国关于多学科专家组诊疗模式(MDT模式)对结直肠癌诊疗影响的临床资料尚无。方法：595例连续结直肠癌病例分为MDT前模式组（297例），MDTh后组（298例），收集包括：TNM分期、组织分型、检测淋巴结数目和阳性数目，放疗、化疗、CT术前分期等。结果：淋巴结检出数量、CT术前分期的准确性在实行MTD后明显优于施行前，有统计学差异。多因素分析显示：年龄、是否实行MDT、淋巴结检出数量、TNM分期是影响患者总体生存的独立因素。结论：对结直肠癌病人实行MDT管理模式对肿瘤术前分期、预后改善有明显影响，而且促进了学科间交流与合作，确保了病人能够获得高质量的、科学的、合理的最佳治疗方案。

The impact of multidisciplinary team (MDT) working in the management of colorectal cancer

Abstract Background The continual and rapid development of techniques which is used for diagnosis and treatment make management of colorectal cancer more difficult depending on single discipline., Colorectal cancer MDT working model is recommended by UK and other countries, but there is little information on the impact of multidisciplinary team (MDT) working on management of colorectal cancer in China. The aim of this study was to assess the effect on management of colorectal cancer after the inception of an MDT. Methods A total of 595 consecutive colorectal cancer patients were referred to the department of gastroenterological surgery, the pre-MDT cohort include 297 patients, recruited from January 1999 to November 2002, and the MDT cohort had 298 patients enrolled from December 2002 to September 2006. Information recorded included: TNM stage from histological reports, degree of differentiation, the number of examined lymph nodes and CT TNM staging performed or not, and its accuracy, including local and distant recurrence,. Results The number of examined lymph nodes and the accuracy of TNM staging by CT in the MDT group were significantly more than those in pre-MDT group. CT TNM staging was more accurate in the MDT group compared to the pre-MDT group (P=0.044). The rate of tumor recurrence in the MDT group was lower than pre-MDT group (log-rank test, P<0.001). Multivariate analysis revealed that age (P=0.001), management after inception of the MDT (P=0.002), degree of differentiation (P=0.003), number of examined lymph nodes (P=0.002), and TNM stage (P=0.000) were important factors that independently influence overall survival. Conclusion The inception of MDT working improved the diagnostic accuracy and overall survival of colorectal cancer patients. MDT working promoted communication and cooperation between disciplines and ensured high-quality diagnosis, evidence-based decision making, and optimal treatment planning.