Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede, The Netherlands.
Acta Oncol. 2020 Apr;59(4):410-416. doi: 10.1080/0284186X.2020.1725240. Epub 2020 Feb 18.
The Dutch guidelines for esophageal and gastro-esophageal junction (GEJ) cancer recommend discussion of patients by a multidisciplinary tumor board (MDT). Despite this recommendation, one previous study in the Netherlands suggested that therapeutic guidance was missing for palliative care of patients with esophageal cancer. The aim of the current study was therefore to assess the impact of an MDT discussion on initial palliative treatment and outcome of patients with esophageal or GEJ cancer. The population-based Netherlands Cancer Registry was used to identify patients treated for esophageal or GEJ cancer with palliative intent between 2010 and 2017 in 7 hospitals. We compared patients discussed by the MDT with patients not discussed by the MDT in a multivariate analysis. Primary outcome was type of initial palliative treatment. Secondary outcome was overall survival. A total of 389/948 (41%) patients with esophageal or GEJ cancer were discussed by the MDT before initial palliative treatment. MDT discussion compared to non-MDT discussion was associated with more patients treated with palliative intent external beam radiotherapy (38% vs. 21%, OR 2.7 [95% CI 1.8-3.9]) and systemic therapy (30% vs. 23%, OR 1.6 [95% CI 1.0-2.5]), and fewer patients treated with stent placement (4% vs. 12%, OR 0.3 [95% CI 0.1-0.6]) and best supportive care alone (12% vs. 33%, OR 0.2 [95% CI 0.1-0.3]). MDT discussion was also associated with improved survival (169 days vs. 107 days, HR 1.3 [95% CI 1.1-1.6]). Our study shows that MDT discussion of patients with esophageal or GEJ cancer resulted in more patients treated with initial palliative radiotherapy and chemotherapy compared with patients not discussed by the MDT. Moreover, MDT discussion may have a positive effect on survival, highlighting the importance of MDT meetings at all stages of treatment.
荷兰食管和胃食管交界处（GEJ）癌症指南建议多学科肿瘤委员会（MDT）对患者进行讨论。尽管有此建议，但荷兰之前的一项研究表明，在食管癌的姑息治疗中缺乏治疗指导。因此，本研究旨在评估 MDT 讨论对食管或 GEJ 癌患者初始姑息治疗和结局的影响。本研究使用基于人群的荷兰癌症登记处，确定了 2010 年至 2017 年间在 7 家医院接受姑息治疗的食管或 GEJ 癌患者。我们在多变量分析中比较了由 MDT 讨论的患者与未由 MDT 讨论的患者。主要结局是初始姑息治疗的类型。次要结局是总生存。共有 389/948（41%）名食管或 GEJ 癌患者在初始姑息治疗前接受了 MDT 讨论。与非 MDT 讨论相比，MDT 讨论与更多接受姑息性意图的外部束放射治疗（38%比 21%，OR 2.7 [95%CI 1.8-3.9]）和全身治疗（30%比 23%，OR 1.6 [95%CI 1.0-2.5]）的患者以及更少接受支架置入（4%比 12%，OR 0.3 [95%CI 0.1-0.6]）和单独最佳支持治疗（12%比 33%，OR 0.2 [95%CI 0.1-0.3]）的患者相关。MDT 讨论还与生存改善相关（169 天比 107 天，HR 1.3 [95%CI 1.1-1.6]）。我们的研究表明，与未接受 MDT 讨论的患者相比，MDT 对食管或 GEJ 癌患者的讨论导致更多患者接受初始姑息性放疗和化疗治疗。此外，MDT 讨论可能对生存产生积极影响，突出了在治疗的所有阶段举行 MDT 会议的重要性。
