Schiffman Suzanne C, Abberbock Shira, Winters Sharon, Valko Cindy, Steve Jennifer, Zureikat Amer H, Zeh Herbert J, Hogg Melissa E
Division of Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania.
Department of Biostatistics, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.
J Surg Res. 2016 May 15;202(2):246-52. doi: 10.1016/j.jss.2016.01.021. Epub 2016 Jan 21.
The purpose of this study was to evaluate the impact of a multidisciplinary clinic (MDC) on the treatment of pancreatic ductal adenocarcinoma. We hypothesized that an MDC would improve trial participation, multimodality therapy, neoadjuvant therapy, time to treatment, and survival.
Pancreatic ductal adenocarcinoma cancer registry patients from 2008-2012 were analyzed. Outcomes of patients evaluated at the MDC were compared with patients not evaluated at the MDC (non-MDC).
A total of 1408 patients were identified, 557 (40%) MDC and 851 (60%) non-MDC. MDC were more likely to be an earlier stage than non-MDC (P = 0.0005): I - 4% versus 4%, II - 54% versus 43%, III - 11% versus 9%, and IV - 32% versus 44%. MDC were younger than non-MDC (68 versus 70; P = 0.005); however, younger (<75) and older (≥75) patients were more likely to receive treatment in MDC than non-MDC. MDC were more likely to participate in trials than non-MDC (28% versus 14%; P < 0.0001). MDC were more likely to receive treatment than non-MDC (90% versus 71%; P < 0.0001). MDC were more likely to receive two (38% versus 24%; P < 0.0001) or three (12% versus 9%; P = 0.02) therapies than non-MDC. No difference in time to first treatment in MDC than non-MDC (0.95 versus 0.92 mo; P = 0.69). After adjusting for age, stage, and therapy, there was a trend; however, no statistical difference in disease-free survival (hazard ratio [HR] of non-MDC versus MDC 0.80; 95% confidence interval [95% CI] 0.61-1.05; P = 0.11), time to recurrence (HR of non-MDC versus MDC 0.69; 95% CI 0.45-1.04; P = 0.07), or overall survival (HR of non-MDC versus MDC 0.81; 95% CI, 0.62-1.07; P = 0.13).
Patients evaluated in an MDC were more likely to receive any treatment, receive multimodality therapy, neoadjuvant therapy, and participate in a clinical trial.
本研究旨在评估多学科诊疗门诊（MDC）对胰腺导管腺癌治疗的影响。我们假设多学科诊疗门诊能提高试验参与率、多模式治疗、新辅助治疗、治疗及时性及生存率。
分析2008年至2012年胰腺导管腺癌癌症登记患者。将在多学科诊疗门诊评估的患者结果与未在多学科诊疗门诊评估的患者（非多学科诊疗门诊患者）进行比较。
共识别出1408例患者，557例（40%）为多学科诊疗门诊患者，851例（60%）为非多学科诊疗门诊患者。多学科诊疗门诊患者比非多学科诊疗门诊患者更可能处于早期阶段（P = 0.0005）：I期 - 4%对4%，II期 - 54%对43%，III期 - 11%对9%，IV期 - 32%对44%。多学科诊疗门诊患者比非多学科诊疗门诊患者年轻（68岁对70岁；P = 0.005）；然而，年轻（<75岁）和年长（≥75岁）患者在多学科诊疗门诊接受治疗的可能性比非多学科诊疗门诊患者更高。多学科诊疗门诊患者比非多学科诊疗门诊患者更可能参与试验（28%对14%；P < 0.0001）。多学科诊疗门诊患者比非多学科诊疗门诊患者更可能接受治疗（90%对71%；P < 0.0001）。多学科诊疗门诊患者比非多学科诊疗门诊患者更可能接受两种（38%对24%；P < 0.0001）或三种（12%对9%；P = 0.02）治疗。多学科诊疗门诊患者与非多学科诊疗门诊患者首次治疗时间无差异（0.95个月对0.92个月；P = 0.69）。在调整年龄、分期和治疗后，存在一种趋势；然而，无病生存率（非多学科诊疗门诊患者与多学科诊疗门诊患者的风险比[HR]为0.80；95%置信区间[95%CI]为0.61 - 1.05；P = 0.11）、复发时间（非多学科诊疗门诊患者与多学科诊疗门诊患者的HR为0.69；95%CI为0.45 - 1.04；P = 0.07）或总生存率（非多学科诊疗门诊患者与多学科诊疗门诊患者的HR为0.81；95%CI为0.62 - 1.07；P = 0.13）无统计学差异。
在多学科诊疗门诊评估的患者更可能接受任何治疗、接受多模式治疗、新辅助治疗并参与临床试验。
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