Bayoud Younes, Loock Pierre Yves, Messaoudi Rabah, Ripert Thomas, Pierrevelcin Jean, Kozal Sebastien, Leon Priscilla, Kamdoum Majorlaine, Irène Cholley, Menard Johann
Department of Urology and Andrology, Robert Debré Academic Hospital, Avenue du General Koenig, Reims 51092, France.
Urol J. 2015 Apr 29;12(2):2078-82.
The prostate cancer (PCa) treatment is multimodal. Thus multidisciplinary team management (MDTM) decision-making process appears as a tool to answer all aspects of PCa treatment. Our aim was to evaluate the reproducibility of therapeutic decisions made at MDTM.
We compared therapeutic decisions of PCa by presenting the same file of patient under a fake identity after 6 to 12 months from the first presentation. Forty-nine files of radical prostatectomy (RP) (28 pT2, 21 pT3) performed for clinical localized PCa were represented at MDTM which included urologist, oncologist, pathologist and radiologist. Analysis of therapeutic decisions comprised criteria such as: TNM stage, Gleason score, margin status and comorbidities. The reproducibility was assessed statistically by Kappa coefficient.
Study subjects included 49 patients who underwent radical prostatectomy (RP). The mean age was similar in pT2 and pT3 groups (P = .09). The mean serum PSA value was 8.32 ng/mL (range, 3.56-19.5) in pT2 group and 9.4 ng/mL (range, 3.8-22) in pT3 group. The margin status in pT2 and pT3 groups was positive in 25.0% and 47.6%, respectively. The decisions made at first and second MDTM for pT2 group were the same in 100% of cases with a perfect kappa coefficient (k = 1). In the group of pT3 (n = 21), the decisions were different in 33% at the second MDTM in comparison to the first MDTM. Especially for pT3b only 29% were reproducible decision with a slight agreement (k = 0.1). Concerning pT3a, 86% of the decisions were reproducible with a substantial agreement (k = 0.74).
We showed a reliability and reproducibility of decision made at MDTM when guidelines are well defined. The therapeutic attitudes were less reproducible in locally advanced PCa but decision concerning those cases should be made in the setting of guidelines.
前列腺癌（PCa）治疗是多模式的。因此，多学科团队管理（MDTM）决策过程成为应对PCa治疗各个方面的一种工具。我们的目的是评估MDTM做出的治疗决策的可重复性。
我们通过在首次展示后6至12个月以假身份呈现相同患者档案来比较PCa的治疗决策。49份因临床局限性PCa进行根治性前列腺切除术（RP）的档案（28例pT2期，21例pT3期）在包括泌尿科医生、肿瘤学家、病理学家和放射科医生的MDTM中展示。治疗决策分析包括TNM分期、Gleason评分、切缘状态和合并症等标准。通过Kappa系数进行统计学评估可重复性。
研究对象包括49例行根治性前列腺切除术（RP）的患者。pT2和pT3组的平均年龄相似（P = 0.09）。pT2组的平均血清PSA值为8.32 ng/mL（范围3.56 - 19.5），pT3组为9.4 ng/mL（范围3.8 - 22）。pT2和pT3组的切缘状态分别有25.0%和47.6%为阳性。pT2组在第一次和第二次MDTM做出的决策在100%的病例中相同，kappa系数完美（k = 1）。在pT3组（n = 21）中，与第一次MDTM相比，第二次MDTM时有33%的决策不同。特别是对于pT3b，只有29%的决策具有可重复性且一致性轻微（k = 0.1）。关于pT3a，86%的决策具有可重复性且一致性较高（k = 0.74）。
我们表明，当指南明确时，MDTM做出的决策具有可靠性和可重复性。局部晚期PCa的治疗态度可重复性较差，但对于这些病例的决策应在指南框架内做出。
