Coory M, Gkolia P, Yang I A, Bowman R V, Fong K M
School of Population Health, The University of Queensland, Public Health Building, Mayne Medical School, Herston Road, Brisbane 4006, Australia.
Epidemiology Services Unit, Health Information Branch, Queensland Health, Brisbane 4001, Australia.
Lung Cancer. 2008 Apr;60(1):14-21. doi: 10.1016/j.lungcan.2008.01.008. Epub 2008 Mar 4.
In several countries, clinical practice guidelines for lung cancer recommend that multidisciplinary (MD) teams should be used to plan the management of all lung cancer patients. We conducted a systematic review to evaluate and critically appraise the effectiveness of multidisciplinary teams for lung cancer.
Medline searches were carried out for the period 1984 to July 2007. We included any study that mentioned team working among specialists with diagnostic and curative therapeutic intent, where members of the team met at a specified time, either in person or by video or teleconferencing, to discuss the diagnosis and management of patients with suspected lung cancer. All study designs were included. We were particularly interested in whether multidisciplinary working improved survival but also considered other outcomes such as practice patterns and waiting times.
Sixteen studies met the criteria for inclusion. Statistical pooling was not possible due to clinical heterogeneity. Only two of the primary studies reported an improvement in survival. Both were before-and-after designs, providing weak evidence of a causal association. Evidence of the effect of MD teams was stronger for changing patient management than for affecting survival. Six of the studies reported an increase in the percentage of patients undergoing surgical resection or an increase in the percentage of patients undergoing chemotherapy or radiotherapy with curative intent.
This systematic review shows limited evidence linking MD teams with improved lung cancer survival. This does not mean that MD teams do not improve survival, merely that currently available evidence of this is limited. It seems intuitively obvious that MD teams should improve outcomes for lung cancer patients, but there are difficulties in conducting randomised trials to show this. The best way forward would be prospective evaluation of the effectiveness of MD teams as they are implemented, paying particular attention to collecting data on potential confounders.
在多个国家，肺癌临床实践指南建议应使用多学科（MD）团队来规划所有肺癌患者的治疗。我们进行了一项系统评价，以评估并严格评价多学科团队对肺癌治疗的有效性。
对1984年至2007年7月期间的医学期刊数据库（Medline）进行检索。我们纳入了任何提及具有诊断和根治性治疗意图的专科医生团队协作的研究，团队成员在特定时间亲自会面，或通过视频或电话会议讨论疑似肺癌患者的诊断和治疗。纳入所有研究设计。我们特别关注多学科协作是否能提高生存率，但也考虑了其他结果，如诊疗模式和等待时间。
16项研究符合纳入标准。由于临床异质性，无法进行统计合并。只有两项主要研究报告了生存率的提高。两项均为前后对照设计，提供了因果关联的薄弱证据。多学科团队对改变患者治疗的效果证据比对影响生存率的证据更强。六项研究报告了接受手术切除的患者百分比增加，或接受根治性化疗或放疗的患者百分比增加。
这项系统评价显示，将多学科团队与提高肺癌生存率联系起来的证据有限。这并不意味着多学科团队不能提高生存率，只是目前关于这方面的现有证据有限。直观上，多学科团队似乎应该能改善肺癌患者的治疗结果，但进行随机试验来证明这一点存在困难。最好的前进方向是在多学科团队实施过程中对其有效性进行前瞻性评估，尤其要注意收集潜在混杂因素的数据。
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