De Luca Stefano, Fiori Cristian, Tucci Marcello, Poggio Massimiliano, Allis Simona, Bollito Enrico, Solitro Federica, Passera Roberto, Buttigliero Consuelo, Porpiglia Francesco
Division of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy -
Department of Oncology, University of Turin, Turin, Italy -
Minerva Urol Nefrol. 2019 Dec;71(6):576-582. doi: 10.23736/S0393-2249.19.03231-4. Epub 2019 Sep 4.
Multidisciplinary team (MDT) management decision-making process appears as an interesting tool to answer most aspects of prostate cancer (PCa) diagnosis and treatment, allowing a fairer choice of therapies. The aim of this study to prospectively investigate the impact on prostate cancer clinical management of the uro-oncology MDT meeting at an Italian tertiary referral center.
All cases discussed over an 18-months period at San Luigi Hospital uro-oncology MDT were prospectively evaluated for the impact of the MDT discussion on PCa clinical decision-making. Dilemma and management plan in the monodisciplinary visit before and/or after primary treatment were recorded. Subsequently, the MDT discussed the case and reached a consensus decision, which was also recorded. Changes in diagnostic assessment and patient management from pre- to post-MDT meeting were evaluated by a consultant urologist.
Overall, 201 patients, of which 99, 81 and 21 with local, advanced and metastatic disease respectively, were selected for MDT evaluation. The most frequent reasons for MDT approach after either PCa diagnosis or primary treatment were metastatic disease or locally advanced disease/positive surgical margins/biochemical recurrence, respectively. Patients with local, advanced and metastatic disease had a significative change of diagnostic/therapeutic management in 23.2%, 46.9% and 33.4%, respectively (P<0.001). Multimodal treatment was recommended in 25.3%.
The uro-oncology MDT meeting alters management plans in at least one-quarter of patients reaching almost 50% of cases in locally advanced disease.
多学科团队（MDT）管理决策过程似乎是一种解决前列腺癌（PCa）诊断和治疗大多数方面问题的有趣工具，能使治疗选择更加公平。本研究旨在前瞻性调查意大利一家三级转诊中心的泌尿肿瘤多学科团队会议对前列腺癌临床管理的影响。
前瞻性评估圣路易吉医院泌尿肿瘤多学科团队在18个月期间讨论的所有病例，以了解多学科团队讨论对前列腺癌临床决策的影响。记录初次治疗前和/或后的单学科就诊中的困境和管理计划。随后，多学科团队讨论该病例并达成共识决策，也进行记录。由一位泌尿外科顾问评估多学科团队会议前后诊断评估和患者管理的变化。
总体上，选择了201例患者进行多学科团队评估，其中分别有99例、81例和21例患有局部、晚期和转移性疾病。前列腺癌诊断或初次治疗后采用多学科团队方法的最常见原因分别是转移性疾病或局部晚期疾病/手术切缘阳性/生化复发。患有局部、晚期和转移性疾病的患者诊断/治疗管理的显著变化分别为23.2%、46.9%和33.4%（P<0.001）。推荐多模式治疗的比例为25.3%。
泌尿肿瘤多学科团队会议改变了至少四分之一患者的管理计划，在局部晚期疾病中这一比例接近50%。
