Chen Chien-Hsin, Hsieh Mao-Chih, Lao Wilson T, Lin En-Kwang, Lu Yen-Jung, Wu Szu-Yuan
Department of Colorectal Surgery, Wan Fang Hospital, Taipei Medical University Taipei, Taiwan.
Department of General Surgery, Wan Fang Hospital, Taipei Medical University Taipei, Taiwan.
Am J Cancer Res. 2018 Sep 1;8(9):1887-1898. eCollection 2018.
To investigate whether multidisciplinary team (MDT) intervention is associated with improved survival for patients with colorectal adenocarcinoma with liver or lung metastasis (CRA-LLM).
We enrolled 161 consecutive patients with histologically confirmed CRA-LLM at Taipei Medical University-Wan Fang Hospital between January 2007 and December 2017. In total, 75 patients with CRA-LLM received MDT intervention, and 86 patients did not receive MDT intervention. To evaluate prognostic factors for overall death, we performed univariate and multivariate Cox regression analyses of the overall death rate in all patients. Overall survival rates were calculated using the Kaplan-Meier method, and Kaplan-Meier survival curves were compared using the log-rank test ( < .001).
A multivariate Cox regression analysis of the overall death rate in patients with CRA-LLM showed that age ≤ 65 years, systemic chemotherapy, curative-intent treatments, and MDT intervention are strong prognostic factors. The adjusted hazard ratio of death risk for age ≤ 65 years, systemic chemotherapy, curative-intent treatments, and MDT intervention were 0.60 (95% confidence interval [CI], 0.40-0.92; = .019), 0.19 (95% CI, 0.12-0.32; = .001), 0.25 (95% CI, 0.13-0.50; = .001), and 0.40 (95% CI, 0.25-0.65; = .001), respectively. The 3-year overall survival rates in patients with CRA-LLM receiving MDT intervention and not receiving MDT intervention were 48.75% and 24.21%, respectively.
MDT intervention is associated with improved survival for patients with CRA-LLM.
探讨多学科团队(MDT)干预是否与结直肠癌伴肝或肺转移(CRA-LLM)患者生存率的提高相关。
2007年1月至2017年12月期间,我们在台北医学大学万芳医院连续纳入了161例经组织学确诊为CRA-LLM的患者。其中,75例CRA-LLM患者接受了MDT干预,86例患者未接受MDT干预。为评估总体死亡的预后因素,我们对所有患者的总体死亡率进行了单因素和多因素Cox回归分析。总体生存率采用Kaplan-Meier法计算,Kaplan-Meier生存曲线采用对数秩检验进行比较(P<0.001)。
对CRA-LLM患者总体死亡率的多因素Cox回归分析显示,年龄≤65岁、全身化疗、根治性治疗和MDT干预是强有力的预后因素。年龄≤65岁、全身化疗、根治性治疗和MDT干预的死亡风险调整后危险比分别为0.60(95%置信区间[CI],0.40-0.92;P=0.019)、0.19(95%CI,0.12-0.32;P=0.001)、0.25(95%CI,0.13-0.50;P=0.001)和0.40(95%CI,0.25-0.65;P=0.001)。接受MDT干预和未接受MDT干预的CRA-LLM患者的3年总体生存率分别为48.75%和24.21%。
MDT干预与CRA-LLM患者生存率的提高相关。