Ear Sciences Centre, School of Surgery, University of Western Australia, Perth, Western Australia, Australia.
Br J Cancer. 2011 Apr 12;104(8):1246-8. doi: 10.1038/bjc.2011.92. Epub 2011 Mar 29.
We analysed the outcomes of 726 cases of primary head and neck cancer patients managed between 1996 and 2008, including those managed in the multidisciplinary clinic or team setting (MDT) and those managed outside of an MDT by individual disciplines (non-MDT) in the same institution.
Data were collected from the Hospital Based Cancer Registry and a database within the Head and Neck Cancer Clinic. Univariable comparisons and multivariable analyses were performed using a logistic regression model. Survival by staging was analysed. Comparisons of management and outcomes were made between MDT and non-MDT patients.
395 patients (54%) had been managed in the MDT vs 331 patients (46%) non-MDT. MDT patients were more likely to have advanced disease (likelihood ratio χ(2)=44.7, P<0.001). Stage IV MDT patients had significantly improved 5-year survival compared with non-MDT patients (hazard ratio=0.69, 95% CI=0.51-0.88, P=0.004) and more synchronous chemotherapy and radiotherapy (P=0.004), and the non-MDT group had more radiotherapy as a single modality (P=0.002).
The improved survival of MDT-managed stage IV patients probably represents both the selection of multimodality treatment and chemotherapeutic advances that these patients received in a multidisciplinary team setting by head and neck cancer specialists as opposed to cancer generalists in a non-MDT setting.
我们分析了 1996 年至 2008 年间管理的 726 例原发性头颈部癌症患者的结果，包括在多学科临床或团队环境（MDT）中管理的患者和在同一机构的 MDT 之外由单个学科管理的患者（非-MDT）。
数据从医院癌症登记处和头颈部癌症诊所的数据库中收集。使用逻辑回归模型进行单变量比较和多变量分析。按分期分析生存情况。对 MDT 和非 MDT 患者的管理和结果进行比较。
395 例（54%）患者在 MDT 中管理，331 例（46%）患者在非 MDT 中管理。MDT 患者更有可能患有晚期疾病（似然比 χ(2)=44.7，P<0.001）。与非 MDT 患者相比，IV 期 MDT 患者的 5 年生存率显著提高（风险比=0.69，95%CI=0.51-0.88，P=0.004），并且更多地接受同步化疗和放疗（P=0.004），而非 MDT 组更多地接受放疗作为单一治疗方式（P=0.002）。
MDT 管理的 IV 期患者的生存改善可能既代表了多模式治疗的选择，也代表了这些患者在头颈部癌症专家的多学科团队环境中接受的化疗进展，而不是在非 MDT 环境中由癌症普通专家接受的治疗。
